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Emphysematous pyelonephritis — ESENeph MCQ

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HardUrological ConditionsEmphysematous pyelonephritisESENeph

A patient with CKD G4 has one PTH result modestly above the assay range, normal calcium, normal phosphate and replete vitamin D. What is the best CKD-MBD response?

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Correct answer: A — Review serial PTH, calcium and phosphate results together

The best answer is “Review serial PTH, calcium and phosphate results together”. KDIGO emphasizes trends and the integrated pattern of PTH, calcium and phosphate rather than treatment of a single modest PTH elevation. “Start calcitriol after this isolated PTH measurement” conflicts with avoiding routine active vitamin D in non-dialysis CKD. “Start cinacalcet before repeating the biochemical profile” is not justified by this isolated finding. “Suppress PTH into the low-normal range with calcium” risks oversuppression and adynamic bone disease. “Begin phosphate binders while serum phosphate remains normal” treats a biochemical abnormality that is not present.

Reference: KDIGO 2017 CKD-MBD guideline update: https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf