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Management of Bone Disorders in Kidney Disease

  • Stuart M. SpragueEmail author
Chapter

Abstract

In healthy individuals, normal serum concentrations of phosphorus and calcium are maintained through the interaction of three hormones: parathyroid hormone (PTH), calcitriol (1,25(OH)2D3), and fibroblast growth factor 23 (FGF-23). These hormones act on four primary target organs: bone, kidney, intestine, and parathyroid glands. The kidneys play a critical role in the regulation of serum calcium and phosphorus concentrations as well as these three hormones. In patients with chronic kidney disease (CKD), increased PTH concentrations are generally the first clinically measured abnormality observed in patients with evolving CKD; however, FGF-23 increases prior to PTH [1, 2]. Shortly following the increases in FGF-23 and PTH, calcitriol concentrations will fall [1]. Changes in these hormones in the early stages of the CKD are an adaptive mechanism to help maintain the serum phosphorus and calcium concentrations in the normal range. It is not until the development of CKD stages 4–5 (glomerular filtration rate less than 30 mL/min/1.73m2) that measurable abnormalities of calcium and phosphorus become apparent [1].

Keywords

Chronic kidney disease Renal osteodystrophy Osteoporosis Hyperparathyroidism Hyperphosphatemia Vitamin D receptor activators Calcimimetics 

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Authors and Affiliations

  1. 1.Division of Nephrology and HypertensionNorthShore University HealthSystemEvanstonUSA
  2. 2.University of Chicago Pritzker School of MedicineChicagoUSA

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