In CKD-MBD, serum Ca and P concentrations are measured at every visit. Serum Ca concentration needs to be corrected if hypoalbuminemia exists. In CKD stages 3–5, serum PTH is measured at least once a year. If it is found out of an optimal range, consultation with nephrologists is recommended. In CKD stages 3–5, administration of active vitamin D and calcium regimens used for osteoporosis may be reduced in dose. Abnormal mineral and bone metabolism in CKD Hypocalcemia, hyperphosphatemia, and disordered vitamin D metabolism in the kidney
are GSK2245840 price intricately involved in the pathophysiology of abnormal bone and check details mineral metabolism in CKD. Furthermore, CKD-MBD may be associated with osteoporosis related to aging or menopause or
with corticosteroids used for underlying diseases, such as glomerulonephritis and nephrotic syndrome. In case of abnormal bone and mineral metabolism related to CKD, consultation with nephrologists is recommended. Diagnosis Secondary hyperparathyroidism appears in CKD stages 3–5. According to the K/DOQI guidelines, an intact PTH (i-PTH) level ≥70 pg/mL is suggestive of secondary hyperparathyroidism. Osteoporosis is diagnosed if there is a history of bone fracture or bone mineral density measurement is less than 70% of the mean value of young adults (YAM). If the bone mineral density is between 70 and PI-1840 80% of YAM, a diagnosis of suspected EPZ015666 order osteoporosis is made. Therapy and follow-up (Tables 22-1, 22-2) Table 22-1 Calcium and phosphate in CKD 1. Under steroid treatment
(CKD stage 1, 2) Give bisphosphonate if persistent use of steroid for more than 3 months. If it is impossible due to adverse reactions, such as gastrointestinal symptoms or pregnancy, give active vitamin D or vitamin K (Japanese Society for Bone and Mineral Research). In CKD stage 3, bisphosphonate can be used; however, it may not be safe. There is a report that PTH may rise with bisphosphonate, therefore, use it with professional acumen 2. Treatment of mineral and bone disorder (CKD-MBD) (1) CKD stage 3, 4 In case of GFR < 60 mL/min/1.73 m2, PTH will increase. Start controlling serum level of phosphate. Restrict protein intake; if not sufficient, give phosphate binders such as CaCO3. If high PTH continues, start low dose of active vitamin D. With progress of CKD stage, control of serum phosphate becomes difficult. If hyperphosphatemia is present, vascular calcification may occur with vitamin D. Vitamin D may need to be decreased or stopped (2) CKD stage 5 Should be treated by nephrologists Quoted, with modification, from: K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease, edited by the National Kidney Foundation.