Touyz RM, de Baaij JHF, Hoenderop JGJ
N Engl J Med. 2024 Jun 6;390(21):1998-2009.
Abstract
Although the past several years have seen substantial advances in the understanding of molecular and cellular mechanisms regulating sodium, potassium, calcium, bicarbonate, and volume homeostasis in health and disease, there has been a paucity of clinically relevant information about disorders of magnesium. Around 1980, magnesium was described as the “forgotten electrolyte,” even though it was and remains recognized as “nature’s … calcium blocker.” Reasons for the apparent lack of appreciation for the clinical significance of magnesium may be due, at least in part, to the lack of information regarding the regulatory processes of this cation at the cellular, tissue, and systems levels.
Although Murphy suggested at the turn of the millennium that it was high time to “unravel … the mysteries of magnesium,” her call was heeded only recently, with a growing appreciation of the role of magnesium in clinical medicine. This change has been facilitated by the discovery of magnesium-specific channels and transporters, as well as the characterization of physiological and hormonal processes that regulate magnesium homeostasis. This review focuses on recent discoveries in how magnesium functions in the body, concentrating on hypomagnesemia, the most common clinical magnesium disorder. Hypermagnesemia is rare and occurs primarily in patients with kidney disease who are receiving magnesium-retaining drugs.
Kidney Physiology 