A 67-year-old man with stage 4 chronic kidney disease returns for labs. Calcium is 8.9 mg/dL, phosphate is 5.6 mg/dL, parathyroid hormone is

Question

A 67-year-old man with stage 4 chronic kidney disease returns for labs. Calcium is 8.9 mg/dL, phosphate is 5.6 mg/dL, parathyroid hormone is elevated, and 25-hydroxyvitamin D is low. He eats processed foods daily. He has no uremic symptoms. Which of the following would you recommend at the follow-up visit?

Accepted Answer

Restrict dietary phosphate and replete vitamin D

Answer

Order parathyroidectomy as first step

Answer

Start aluminum-containing antacids indefinitely

Answer

Give high-dose calcium without monitoring

Answer

Begin dialysis based on phosphate alone

Chronic kidney disease mineral bone disease — USMLE Step 3 MCQ