A 74 year old gentleman with chronic kidney disease stage IV is referred to clinic by his GP complaining of'painful bones'. You undertake some routine investigations which show the following:

Urea 14 mmol/l

Creatinine 215 µmol/l

Adjusted Ca 2.38 mmol/l

Phosphate 1.68 mmol/l

PTH 28 mmol/l

What drug should you commence?

Raloxifene

Cinacalcet

Ramipril

Alendronic acid

1-alfacalcidol

This patient has evidence of mineral bone disease resulting from chronic kidney disease (CKD). Secondaryhyperparathyroidism is a common complication of CKD and is associated with hyper- or hypocalcaemia,hyperphosphataemia and a raised serum PTH. Treatment options include calcium replacement, phosphatebinders, vitamin D analogues or parathyroidectomy (in patients with resistant tertiaryhyperparathyroidism).

1-alfacalcidol is the preferred first-line vitamin D analogue in pre-dialysis patients. Cinacalcet is licensedfor treatment of secondary hyperparathyroidism in dialysis patients.

Chronic kidney disease: bone disease management

Question 11 of 31

2+

Rate, discuss and give feedback on this question

Next question

Chronic kidney disease: bone disease management

Aimsreduce hyperphosphataemiareduce PTH level

Managementphosphate bindersvitamin D

Phosphate bindersaluminium containing binders are no longer usedcalcium based binders much more commonproblem is vascular calcificationnon-calcium based agents currently being developed

(http://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/xrb184b.jpg)© Image used on license from

Radiopaedia

(http://www.radiopaedia.org/)(http://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/xrb184b.jpg)

X-ray of a Brown tumour caused by secondary hyperparathyroidism in ayoung female with chronic kidney disease

Save my notes

Rate, discuss and give feedback on this question

Discuss, correct and update the 'Chronic kidney disease: bone disease management' notes

Next question

Question stats

A 3.8%

B 43.4%

C 0.9%

D 10.9%

E 41%

41% of users answered this question correctly

Search Passmedicine

Open MRCP Part 2 Written textbook (../review/textbook.php)

External links

Suggest a link

Google search on "Chronic kidney disease: bone disease management" (https://www.google.co.uk/#q=Chronickidney disease: bone disease management )

Go

+

Dashboard

Overall score: 81.8%

1

2

3

4

5

6

7

Search term

Back to topAll contents of this site are © 2015 Passmedicine Limited

8

9

10

11