REGULATION OF CALCIUM, MAGNESIUM AND

PHOSPHATE BALANCE
OBJECTIVE
1. Describe the distribution of Ca++, Mg++ and PO4 --- in the body and
their physiological significance.
2. Identify the forms of Ca, Mg and PO4 in plasma , and explain the relationship to the amount of Ca,Mg and PO4 that is filtered.
3. Explain how the body maintains Ca, Mg and PO4 homeostatsis and the
relative importance of the kidney vs the gastroinstestinal tract and bone
4. Describe the hormones and factors that regulate plasma Ca,Mg, and PO4
levels.
5. Explain the cellular mechanisms of Ca, Mg and PO4 reabsorption and
identify the nephron sites at which their excretion is regulated.
6. Describe the hormones that regulate Ca, Mg and PO4 excretion

Diet : 1000 mg

Gut

Faeces
825 mg

Absorbed 500
Secreted 325

Calcium pool

Formation
280 mg
Resorption
280 mg

Reabs
Filtered
9,825
10,000
kidneys

Urine
175

Overview of Ca++ homeostasis

bone

BODY CONTENT AND DISTRIBUTION OF Ca, Mg AND PO4

ION

BODY
CONTENT

BONE

ICF

ECF

Ca ++

1,300 gm

99%

1%

0,10%

Mg++

26 gm

54%

45%

1,00%

PO4---

700 gm

86%

14 %

0,03%

FORMS OF Ca ++, Mg ++ AND PO4 IN PLASMA

Precentage of total

Ion

meq/l

ionized

prot. Bound

complexed

Ca++

50

45

Mg++

55

30

15

PO4

84

10

HOMEOSTASIS Ca++
1. KADAR CALCIUM PLASMA
2. PARATHYROID HORMON (PTH)
3. 1,25(OH)2 D3

Ca ++ TRANSPORT ALONG THE NEPHRON

NORMAL : 99% DIREABSORBSI

70 % DI TUBULUS PROKSIMAL
20% DI LOOP HENLE (TERUTAMA THICK ASC)
5-10% DI TUB. DISTALIS
< 5 % DI TUB. KOLEKTIVUS
+- 1 % DIEKSKRESI KE URINE

Tubular
fluid

BLOOD

trascellular

ATP

Ca++
Ca ++
3mEq/L

Ca++

Ca++
0,2uEq/L

3Na

paracellular

REGULALATION OF Ca++ EXCRETION

PARATHYROID HORMONE (PTH)

STIMULATES Ca REABSORP.
ASIDOSIS----INCREASE Ca EXCRETION
1,25 (OH)2D3--- DECREASING Ca EXCRETION
PO4 LOADING OR DEPLETION
LOADING : DECREASING EXCRETION

Diet : 280mg

Gut

Faeces
205 mg

Formation

Absorbed 125
Secreted 50

Mg ++ pool
Resorption

Reabs
Filtered
2,445
2,520
kidneys

Urine
75

Overview of Mg ++homeostasis

Bone and
Soft tissue

Mg ++ TRANSPORT ALONG THE NEPHRON

PROXIMAL TUB : 30 % REABSORPTION

THICK ASCENDING LIMB OF HENLES LOOP
: 65% REABSORPTION
DISTAL AND COLECTING DUCT
: <2% RABSORPTION
EXCRETION OF Mg : 3% OF THE FILTERED

HORMONES AND FACTORS INFLUENCING

URINARY Mg++ EXCRETION

INCREASE EXCRETION

DECREASE EXCRETION

Hypercalcemia
Hypermagnesemia
ECF expansion
Decrease of PTH
Acidosis

hypocalcemia
hypomagnesemia
ECF contraction
In crease of PTH
Alkalosis

Diet : 1,400mg

Gut

Faeces
500mg

Absorbed 1100
Secreted 200

PO4 pool

Formation
210mg
Resorption
210 mg

Reabs
Filtered
6,100
7,000
kidneys

Urine
900

Overview of PO4 ---homeostasis

Bone and
Soft tissue

PO4 TRANSPORT ALONG THE NEPHRON

PROXIMAL TUB : 80% REABSORPTION

DISTAL TIBULE : 10% RABSORPTION
LOOPS OF HENLE AND COLECTING DUCT
: NEGLIGIBLE
XCRETION OF PO4 10 % OF THE FILTERED

HORMONES AND FACTORS INFLUENCING

URINARY Mg++ EXCRETION

INCREASE EXCRETION

DECREASE EXCRETION

PO4 LOADING
ECF expansion
Increase of PTH
Acidosis
glucocorticoid

PO4 DEPLETION
ECF contraction
Decrease of PTH
Alkalosis

Tubular
fluid

BLOOD

Na +
2 Na

HPO4
/H2PO4

K+
HPO4
/H2PO4

A-