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CKD-MINERAL AND BONE DISORDER

Nephrology

CKD-MINERAL AND BONE DISORDER

1. Chronic kidney disease-mineral bone disorders (CKD-MBD) = high PO 4 + low/normal Ca + high PTH + low activated Vit D.

2. As GFR declines, PO 4 excreation decreases, levels remain normal until ~ stage 3 CKD.

3. PO 4 accumulation stimulates PTH release => leads to increased bone calcium resorption => Ca + PO 4 deposit in the vasculature & tissue. Low GFR leads to decreased activated Vit D.

4. Hyperphosphatemia is associated with an increased risk of death and heart disease. Treat with phosphate-binders, which can be calcium based (not used now), non-calcium-based (sevelamer/Renagel).

5. Ideal management is to control phosphorus with diet and binder, which leads to normalization of phosphorous, increased Ca, and decreased iPTH.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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