Serum FGF23 is markedly elevated in chronic kidney disease and has been associated with poor long-term outcomes. FGF23 expression is increased by activation of the FGF receptor 1 (FGFR1) in rats with normal renal function and in vitro in bone-derived osteoblast-like cells. We studied the regulation of FGF23 by FGFR1 in vivo in acute and chronic uremia in mice and rats. Folic acid-induced acute kidney injury increased calvaria FGF23 mRNA and serum FGF23 and parathyroid hormone (PTH) levels at 6 h. The FGFR1 receptor inhibitor PD173074 prevented the folic acid-induced increase in both FGF23 mRNA and serum levels but had no effect on serum PTH levels. A more prolonged uremia due to an adenine high-phosphorus diet for 14 days resulted in high levels of FGF23 mRNA and serum FGF23 and PTH. PD173074 decreased serum FGF23 and mRNA levels with no effect on PTH in the adenine high phosphorus-induced uremic rats. Therefore, a derangement in FGF23 regulation starts early in the course of acute kidney injury, is in part independent of the increase in serum PTH, and involves activation of FGFR1. It is possible that FGFR1 in the osteocyte is activated by locally produced canonical FGFs, which are increased in uremia. This is the first demonstration that activation of FGFR1 is essential for the high levels of FGF23 in acute and chronic experimental uremia.FGF23; FGFR; acute kidney injury; uremia FGF23 IS PRODUCED BY OSTEOCYTES and osteoblasts, binds to its receptor, the fibroblast growth factor receptor 1 (FGFR1)-klotho heterodimer, in the kidney to cause a phosphaturia and decrease the synthesis of 1,25(OH) 2 vitamin D (25, 10). In addition, FGF23 acts on the FGFR1-klotho in the parathyroid to decrease parathyroid hormone (PTH) gene expression and parathyroid cell proliferation (2). In chronic kidney disease (CKD), there are extremely high levels of serum FGF23, which is one of the markers of the increased mortality in these patients (13). FGF23 also acts independently of klotho through FGFR1 and the calcineurin pathway in the heart and parathyroid (6,8,21). The synthesis and secretion of FGF23 by osteocytes are increased by a number of systemic factors (26). PTH acts through the nuclear orphan receptor nurr1, which binds to the FGF23 gene promoter to increase FGF23 transcription by PTH/PKA signaling (17). Conserved Nurr1 elements in the FGF23 proximal promoter and immediately preceding the start site for transcription mediate the increase in FGF23 transcription by PTH (20). FGF23 expression is also enhanced by 1,25(OH) 2 vitamin D, which binds to a vitamin D-response element (VDRE) in the FGF23 promoter (15). One of the Nurr1 elements at the Ϫ200-to Ϫ399-bp region of the mouse FGF23 promoter is part of a VDRE in the FGF23 promoter (14). This vitamin D receptor (VDR)/Nurr1-element mediates the effect of 1,25(OH) 2 vitamin D and is a cisregulatory module anchored by adjacent ETS1, a transcription factor that cooperates with VDR (4, 24), and VDRE/Nurr1 sites (14). Calcium, phosphorus retention in the milieu of CKD, metabolic aci...