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 !
- Slides: 48