CKDMBD WHATS NEW DR ANKUR GUPTA DM NEPHROLOGY

CKD-MBD: WHAT’S NEW DR ANKUR GUPTA DM NEPHROLOGY (AIIMS) MRCP NEPHROLOGY (UK) FELLOWSHIP HYPERTENSION & RENAL TRANSPLANT (OTTAWA, CANADA) SENIOR CONSULTANT NEPHROLOGY MA MAX, SHALIMAR BAGH & PITAMPURA.

CKD-MBD Lab abnormalities ▪ Bone abnormalities ▪ Tissue calcifications ▪ 2

OLD NEW 3

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Vit D def & s. HPT : early ckd 6

Phosphate levels in ckd 7

Renal response 8

Phosphate balance 9

P- Toxin ▪ P binder- Cal based or Non Cal based Tolerance Adherence Clinical effectiveness ▪ One that patient will take ▪ ▪ ▪ 10

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Phosphate binders 12

FGFs 13

fgf-23 on Proximal tubules 14

fgf-23 on Distal tubules 15

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fgf-23 dysregulation 17

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Klotho down regulation in CKD 19

Klotho interaction in CKD 20

Proposed strategies in CKD 21

Vascular calcification 22

Medial arterial calcification vs atherosclerosis in CKD 23

Osteogenic transdifferentiation of VSMC in CKD 24

Bone turnover & vascular ossification in CKD 25

Calcified vessels on burn turnover in CKD 26

Possible Rx of Vascular calcification in CKD 27

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Calcimimetics 30

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▪ PLOS Medicine 2013 33

Parathyroidectomy-indications 34

progression 35

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Vit D 38

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Calciphylaxis 41

Cont… 42

Lab evaluation- which test when 43

2016 44

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Take home words ▪ KLOTHO ▪ FGF-23 47

Thank you !