Chronic kidney disease/bone and mineral metabolism: the imperfect storm.

Abstract:

:As kidney function declines, chronic kidney disease (CKD) becomes an increasingly systemic disorder. Most patients with CKD eventually develop subclinical or clinical abnormalities in bone and mineral metabolism. Recent observational and basic scientific studies have led to a new emphasis on the changes in phosphorus and calcium metabolism, parathyroid hormone, and vitamin D that lead to this complex systemic bone/mineral disorder (CKD/BMD). At the center of the disorder are relationships among all 4 factors that conspire to create a perfect storm, leading to secondary hyperparathyroidism (SHPT). Some key current issues that are reviewed here are as follows: (1) factors promoting SHPT, (2) the role of fibroblast growth factor-23 in CKD/BMD, (3) molecular mechanisms of SHPT, (4) mechanisms of vascular calcification, and (5) medical management of the disorder, including calcimimetics. Current therapies directed at correcting the primary abnormalities (ie, improve conditions to an imperfect storm) and minimizing the consequences of CKD/BMD are discussed.

journal_name

Semin Nephrol

journal_title

Seminars in nephrology

authors

Williams ME

doi

10.1016/j.semnephrol.2009.01.002

subject

Has Abstract

pub_date

2009-03-01 00:00:00

pages

97-104

issue

2

eissn

0270-9295

issn

1558-4488

pii

S0270-9295(09)00003-5

journal_volume

29

pub_type

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