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Mineral Bone Dx x CKD
Terms in this set (40)
what minerals can CKD causes imbalances with?
and may lead to
what condition in your thyroid can CKD lead to?
d/t the imbalances with phos, calcium, and vit D
what 3 receptors are located in the thyroid gland that regulate vit D, phos, and calcium homeostasis?
1. calcium sensing receptor (CaSr)
2. Vitamin D (VDR)
3. FGF-23 receptor
makes sure we have enough calcium
Kidney x Parathyroid Hormone
renal absorption of calcium
excretion of phosphorous
stimulate synthesis of calcitriol
Intestines x Parathyroid Hormone
increases absorption and Ca and Phos in small intestine
Bone x Parathyroid Hormone
Stimulates Osteoclasts and inhibits Osteoblasts --> releases more free vitamin D by breaking down bone
causes increased PTH
2. decrease production of
(bc your kidney gets rid of it when PTH is increased!)
how is hyperparathyroidism determined?
primary is an innate error, secondary is d/t CKD, tertiary from other reasons
how does CKD induce secondary hyperparathyroidism?
CKD --> waste products
begin to accumulate d/t not well functioning excretory system --> this increases
and phos levels --> parathyroid gland is put in
when does secondary hyperparathyroidism begin progressive?
GFR < 60
why is important to treat secondary hyperparathyroidsim/outcomes if not properly treated?
can lead to
hyperplasia of parathyroid gland and creased Calcium SR and VDR sensitivity
this can lead to:
1. potentail adenomatous
2. osteoporosis (increased fractures d/t increaed osteoclasrs from PTH in overdrive)
4. calcification of skin
vascular calcification that happens when body becomes
less sensitive to calcium serum levels
arteries thicken -->
increase in Left Ventricular Hypertrophy
--> arthersclerotic load increase -->
Activated by sun as
cholecalciferol vit D3
which goes to liver and and then kidney and is converted to
calcitriol by 1-alpha hydroxylase
phos and vit D
what does FGF do at the parathyroid gland?
what does FGF do at the kidney?
inhibits 1-alpha hydroxylase
production of calcitriol
how do you diagnose a bone dx?
but that is difficult so most people
measure PTH levels
increased osteoclast and osteoblasts activity, consistent
elevation of PTH to be above 300
adynamic bone diseases
remineralization is not happening
and low number of osteoblasts and osteoclasts,
iPTH is <150
caused by suppression of PTH by phosphate binders, vit D tx, or calcimemetics
indirect stimulator of PTH
, and kidneys do not excrete phosphorous well in CKD (or excrete anything well)
how do you treat hyperphosphotemia?
bc phos is in everything good
can be used to bind elevated levels of phosphate but be careful running risk of
must separate dosing with tacro, mycophenolate, and cyclosporine
trivalent cation that
what do you separate
all phos binders from
TFL-> Toe Flick Lick
why do we use phos binders?
to correct hyperphosphotemia because elevated levels --> increase PTH
lab value used to measure function of parathyroid
iPTH levels KDIGO
for CKD patients so around
iPTH for osteitis fibrosa
>300 --> high bone turnover --> more deterioration
iPTH for adynamic bone disease
<150 --> low bone turnover --> increase risk of osteoperosis
when do you use vitamin D or vitamin D analogs?
only in G4 or G5 for
G1 --> >90
G2 --> 60-89
G4 --> 15-29
G5 --> <15
vitamin D analog
2nd in potency of vitamin D analog, given as a pro-drug
vitamin D analog with lowest incidence of hypercalcemia and hyperphosphotemia
by increases sensitivity of
in parathyroid gland -> tricks gland into
thinking there is enough Ca to PTH is not released
correct calcium must be above 8.4 to administer
start dosing at
and dose adjust every 4 weeks*
how long should you hold cinacalcet before drawing pth levels?
12 hours prior to drawing labs because
it falsely lowers PTH levels
used only in HD patients,
requires frequent monitoring,
re check calcium at one week
every 4 weeks
what happens if you switch from cinacalcet to etecalcetide?
dc calcetide for 7 days
Inactive Vitamin D (Ergocalciferol)
NOT used for CKD stage 5 patients, and
not for CKD
--> must be activated by kidneys --> does not really work -->
CKD patients will not be able to activate this
Serum Calcium + 0.8 (4-serum alb)
THIS SET IS OFTEN IN FOLDERS WITH...
Lecture 7-CKD 1
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Lecture 11: Dialysis
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