as kidney function declines, there is a decrease in phosphate elimination-hyperphosphatemia; PTH hormone is released because of hypocalcemia; this decreases phosphate reabsorption
Explain Pathway 1 of CKD-MBD.
as kidney function declines, there is a decrease in phosphate elimination-hyperphosphatemia; this leads to PTH stimulation (independent of calcium); calcium reabsorption occurs and phosphate reabsorption decreases
Explain Pathway 2 of CKD-MBD.
the decline in kidney function results in hyperphosphatemia; this impairs vitamin D bioactivation directly/indirectly through FGF-23; causes Vit D deficiency and impaired calcium uptake
Explain Pathway 3 of CKD-MBD.
the decline in kidney function results in impaired vitamin D activation; leading to hypocalcemia
Explain Pathway 4 of CKD-MBD.
d
Which is strictly the result of a vitamin D deficiency?
a) pathway 1
b) pathway 2
c) pathway 3
d) pathway 4
c
Which is the result of hyperphosphatemia-induced Vit D deficiency?
a) pathway 1
b) pathway 2
c) pathway 3
d) pathway 4
b
Which is the result of hyperphosphatemia-induced hyperparathyroidism?
a) pathway 1
b) pathway 2
c) pathway 3
d) pathway 4
a
Which is the result of hyperphosphatemia-induced hypocalcemia?
a) pathway 1
b) pathway 2
c) pathway 3
d) pathway 4
kidneys can still respond to PTH hormone and decrease phosphorus reabsorption due to increased renal tubular secretion
How do the kidneys respond to PTH hormone in early CKD?
kidneys can no longer respond to PTH hormone; this results in sustained PTH secretions which further compromises bone health
How do the kidneys respond to PTH hormone in Late CKD?
decreased; decreased
Hyperphosphatemia will lead to _____ Vitamin D activation and _______ calcium absorption.
hydroxyapatite; bone/tooth enamel
Phosphorus + calcium = ?
What is this the primary structural component of?
PTH; FGF23
_______ & _______ reduce tubular reabsorption of Phosphorus.
2.7-4.5 mg/dL
What are the normal serum levels of phosphorus?
>5mg/dL
Hyperphosphatemia=
decreased renal tubular secretion despite elevated levels of PTH and FGF23
What is the most common cause of hyperphosphatemia?
calcium acetate, calcium carbonate, ferric citrate, lanthanum, sevelamer
What are the calcium binders? (5)
b
Which dissociates into ions that bind phosphate?
a) ferric citrate
b) lanthanum
c) calcium acetate
d) Sevelamer
d
Which exchanges Cl ions for phosphate?
a) ferric citrate
b) lanthanum
c) calcium acetate
d) Sevelamer
d
Which acts in the intestinal lumen?
a) ferric citrate
b) lanthanum
c) calcium acetate
d) Sevelamer
metabolic acidosis; due to left over Cl ion
AE of Sevelamer?
calcium gluconate, calcium chloride
What are the IV calcium supplements? (2)
calcium carbonate, calcium citrate
What are the oral calcium supplements? (2)
reduced GI absorption, reduced tubular reabsorption, coma, epilepsy
What are the most common causes of hypophosphatemia? (4)
peptic ulcer disease, history of alcoholism
Which patients will have reduced GI absorption of Phosphorus? (2)
sodium phosphate
What is the most common strategy to treat Hypophosphatemia?