Nephrology
Pediatric Nephrology

Hyperphosphatemia associated with chronic kidney disease (CKD).

The progressive loss of kidney function leads to the appearance of elevated blood phosphorus levels, which is known as hyperphosphatemia. Normal figures range from 2.5 to 4.5 mg/dl. However, in stages 3b and later of chronic kidney disease, elevated blood phosphorus values ​​may appear. The presence of hyperphosphatemia in the blood is influenced by several factors such as a diet rich in proteins and/or foods that provide high phosphorus content (for example, processed meals such as frozen meals, pizzas, sauces, etc.), and impaired kidney function. There are treatments indicated to control hyperphosphatemia associated with CKD, the so-called phosphate binders, which together with certain dietary measures can help patients to control Hyperphosphatemia. Hyperphosphatemia has been identified as a risk factor in the progression of CKD as well as a risk factor for cardiovascular events. Inadequate control of hyperphosphatemia has been associated with increased mortality.

 

Hyperparathyroidism associated (secondary) with CKD.

Parathormone or PTH is produced in the parathyroid glands, which are located on the anterior side of the neck next to the thyroid. There are 4 of them and they are about the size of a lentil. PTH is a very important hormone in the regulation of phosphorus, calcium and vitamin D levels. When the amount of phosphorus rises slightly in the blood (or when the amount of calcium falls), more PTH hormone is produced. It acts on the kidney by increasing the elimination of phosphorus in the urine and reducing calcium loss. In CKD (Chronic Kidney Disease), there is a decrease in active vitamin D and an excess of phosphorus, which causes an excess of PTH production on a sustained basis. This causes an increase of the size of the he parathyroid glands (hypertrophy). This situation is known as hyperparathyroidism secondary to CKD. The treatment of this disease is controlled by the nephrologist. Analogues of vitamin D (which benefits the patient for two reasons: there is a deficiency of this vitamin in CKD and it is a stimulus to stop the overproduction of PTH) are used in the treatment of secondary hyperparathyroidism. Another group of drugs used in the treatment of secondary hyperparathyroidism are called calcimimetics.