Does this patient have hypercalcemia? Key elements in the history Diagnosed through routine labs If severe may be associated with symptoms (see below) Typically accompanied with other mineral metabolism abnormalities May be a consequence or may be exacerbated by therapy used to treat disordered mineral metabolism An indicator of severity of secondary hyperparathyroidism Key symptoms…
Does this patient have hypocalcemia? Abnormal calcium metabolism is one of the components of the laboratory abnormalities in the CKD-MBD syndrome. Decreased conversion of storage form of vitamin D, 25-hydroxyvitamin D, to calcitriol, 1,25-dihydroxyvitamin D, results in decreased gastrointestinal calcium absorption and may be accompanied by hypocalcemia without treatment. Key elements in the history Evaluate…
Does this patient have Vitamin D deficiency? Vitamin D deficiency (low levels of 25-hydroxyvitamin D) is common in patients with chronic kidney disease, including patients on dialysis. Etiology is likely multifactorial but may be related to diminished capacity of vitamin D production by skin, limited exposure to sunlight, reduced intake of foods rich in vitamin…
Does this patient have secondary hyperparathyroidism? Overview of diagnosis Elevation in parathyroid hormone (PTH) levels secondary to mineral metabolism abnormalities that accompany CKD KDOQI definition: intact PTH levels above the 150-300 pg/ml range KDIGO definition: intact PTH levels above 2-9 times the upper normal limit for the intact PTH assay Usually diagnosed by routine lab…
Does this patient have hyperphosphatemia? Signs and symptoms Typically detected by routine laboratory tests Symptoms may include pruritus, bone or joint pain Signs may include radiographic evidence of vascular calcification, eye deposition leading to red eye or conjunctivitis, and calciphylaxis Values may vary depending on time of day (circadian variation), prandial status, relationship to timing…
