chronic kidney disease 2 Flashcards
When does secondary hyperparathyrodism occur?
Give an example?
second to metabolic abnormalties of CKD
hyper phosphatemia in conjuction with a decrease in conversion of vitamin D to its active form- leads to hypocalcemia- which is a stimlus for release of PTH
What does hyperparathyroidism lead to?
progressive bone disease
Why is management of hyperparathyroidism needed?
What is this?
to prevent renal osteodystrophy
global term applied to all bone abnormalities seen in patients with CKD
Why do complications develop”
Give examples
abnormal phosphorous and calcium homeostatis
osteitis fibrosa cystica (high bone turnover), osteomalacia (low bone turnover), adynamic bone disease
What is the tx of renal osteodystrophy prevent?
how
prevention of hyperphosphatemia by supressing the secretion of PTH in patients with acquired calcitriol deficiency
What is the treatment plan for renal osteodystrophy?
What is rare treatment?
administration fo calcitriol, vitamin D analogs or calcimimetics
parathyroidectomy for severe refractory hyperparathyrodism
what happens as kidney function declines?
What happens to the calcium?
How does this effect PTH?
decrease in phosphorus elmination which results in hyperphosphatemia
decrease calcium
What results due to calcium-phosphate product?
high phosphate increase PTH, low calcium stimulates PTH
What are two approaches to lower phosphate?
increased mortality- precipitation in arteries, joints, soft tissue, viscera
restrict diet, use agent to bind phosphate in the gut
what are the normal calcium levels for normal people?
ESRD?
- 0-10.5
8. 4-9.5
What is normal phosphourous
ESRD
- 7-4.6
3. 5-5.5
What is the recommendation of phosphate in the diet?
800-1000 mg/day
What should you do if PO4 and PTH can’t be controlled by dietary restriction?
use phosphate binders
what do phosphate binders do?
decrease phosphours absorption and serum levels of PO4 by forming insoluble phosphate complexes that are excreted in the stool
What are the options for phosphate binders?
When should patients take these medications?When are these used as initial therapy?
ca, al, mg, and sevelamer HCL
with meals
stages 3-5
