CKD Mineral and Bone Disorder Flashcards Preview

Week 50: CKD > CKD Mineral and Bone Disorder > Flashcards

Flashcards in CKD Mineral and Bone Disorder Deck (9)
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1

PTH acts on what 3 things? Directly or indirectly?

Directly on bone and kidney
Indirectly on intestine

2

Calcitriol

1,25 (OH)2 Vitamin D
Potent
Main active vitamin D metabolite
Acts on bone, kidney and intestine

3

FGF-23

Fibroblast growth factor-23
Expressed in osteocytes
Acts on FGF receptors in concert with the necessary protein co-factor Klotho

4

PTH effect on
1. Bone
2. Kidney
3. Intestine

1. Increases Ca and PO4 resorption
2. Increases Ca resorption, increase PO4 excretion, increases calcitriol activation
3. Indirect effect through increased calcitriol

5

Calcitriol effect on the
1. Bone
2. Kidney
3. Intestine

1. Increase Ca resorption, increase PO4 resorption
2. Same
3. Same

6

Fgf-23 effect on the
1. Bone
2. Kidney
3. Intestine

1. Uncertain
2. Increase PO4 excretion, decrease calcitriol activation
3. Indirect effect through decreased calcitriol

7

Normal result of
1. Increase PTH
2. Increased Calcitriol
3. Increases FGF-23

1. Increase serum Ca, net effect to mildy reduce serum PO4
2. Increase both serum Ca and serum PO4
3. Reduce serum PO4 and reduce calcitriol activation

8

3 treatment targets in the secondary hyper PTH of CKD

Hyperphosphatemia
Hypocalcemic
Decreased calcitriol activation

9

Treatment of CKD-MBD

Limit persistent hyperphosphatemia (oral, then binders)
Consider normalizing serum Ca
Consider calcitriol use only in more advanced CKD with rising/severe hyperPTH
In dialysis patients, consider using calcimimetics to improve PTH gland sensitivity to Ca
Maintain target PTH level for degree CKD