Magnesium renal tubular reabsorption

Tables 63-6.5 list some of the causes that affect plasma calcium, magnesium, and phosphate. Increased plasma calcium concentration may occur when the xeno-biotic specifically targets calcium metabolism, behaves similarly to vitamin D, and causes hyperparathyroidism or renal disease. Lead and cadmium enter bone and inhibit bone growth, increase calcium release from bone, and inhibit renal tubular reabsorption of calcium salts lead inhibits the renal bioactivation of 25-hydroxy-cholecaliciferol (Sauk and Somerman 1991). In longer-term studies, increased plasma calcium may be associated with tumor burden. Because roughly half of circulating calcium is bound to plasma albumin, hypercalcemia can also arise from dehydration. Hypoparathyroidism, pancreatitis, and renal disease can reduce plasma calcium. Acidosis increases plasma-ionized calcium concentrations, whereas alkalosis causes a decrease due to the effects of pH in the ECF or on protein binding.

Renal magnesium wasting is the main mechanism responsible for the hypomagnesemia associated with cisplatin (172), and it can be associated with enhanced tubular reabsorption of calcium and consequent hypocalciuria (173). This dissociation in the renal handling of calcium and magnesium is similar to what is found in Bartter s syndrome. The site of the renal tubular defect in these conditions is not known, but there is evidence that active renal tubular transport systems are disrupted. 

While alcohol abuse may be associated with a variety of electrolyte and acid-base disorders, the role of the kidneys in this process has only recently been fully defined [164]. Renal functional abnormalities have now been related to chronic alcoholism in patients without liver disease and these defects have reverted to normal with abstinence from alcohol abuse. These abnor-mahties include decreases in the maximal reabsorptive abihty and threshold for glucose, a decrease in the threshold for phosphate excretion, and increases in the fractional excretion of P2-microglobulin, uric acid, calcium, magnesium, and amino acids. Defective tubular acidification and impaired renal concentrating ability... 

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