{"id":7727,"date":"2021-10-24T12:12:09","date_gmt":"2021-10-24T10:12:09","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/complications-of-chronic-kidney-disease-atherosclerosis-anaemia-disturbances-of-ca-p-metabolism\/"},"modified":"2022-01-05T12:16:05","modified_gmt":"2022-01-05T10:16:05","slug":"complications-of-chronic-kidney-disease-atherosclerosis-anaemia-disturbances-of-ca-p-metabolism","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/complications-of-chronic-kidney-disease-atherosclerosis-anaemia-disturbances-of-ca-p-metabolism\/","title":{"rendered":"Complications of chronic kidney disease (atherosclerosis, anemia, disturbances of Ca-P metabolism)"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Atherosclerosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Atherosclerosis is a type of arteriosclerosis (stiffening of arteries) in which there&#8217;s a thickening of the intimal layer of the vessel wall due to the deposition of lipids, and sustained inflammation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By itself, atherosclerosis is both the result and the contributor to the development of CKD.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CKD appears to contribute to the acceleration of atherosclerosis by several mechanisms:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Induction of pro-inflammatory changes in the immune system<\/li><li>Modification of lipoproteins<\/li><li>Increase in cholesterol crystal formation<\/li><li>Increase in calcium deposition<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Furthermore, CKD contributes to HTN through a vicious cycle maintained by the RAAS system, additionally forming a pro-atheromatic environment.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Anemia<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Anemia is the reduction of the oxygen-carrying capacity of the blood due to a decrease in the hemoglobin, or volume of red blood cells.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The kidney produced erythropoietin, which is crucial for the production of red blood cells.<\/li><li>Renal atrophy leading to the lack of erythropoietin.<\/li><li>DD: iron-deficiency anemia, B12\/folate deficiency, hypothyroidism<\/li><li>Dx: serum hemoglobin, TBC<\/li><li>Tx: recombinant EPO injections. 3000-4000IU 1-2x\/week + iron. Monitor Htc and Hgb levels to reduce risk of stroke. May worsen HTN<\/li><li>Marrow fibrosis in osteitis fibrosa cystica can worsen anemia and contribute to EPO resistance<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Calcium-phosphate metabolism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Reduced phosphate excretion and loss of Ca2+ lead to increase in<strong> FGF-23<\/strong> (suppresses calcitriol and vit D) and <strong>PTH<\/strong><\/li><li>The mainly affected tissues are the bones, cardiovascular system, and soft tissues<\/li><li><strong>Renal osteodystrophy<\/strong>, which can take any or mixed forms of the following:<ul><li>High turnover: <strong>osteitis fibrosa cystica<\/strong> (increased bone resorption and deposition, marrow fibrosis, cysts [in the jaw], brown tumors); classic lesion of 2ndary hyper-PTH<\/li><li>Low turnover: <strong>adynamic bone disease <\/strong>(reduced bone volume and mineralization, due to suppressed PTH, typically due to excess calcium; iatrogenic &#8211; calcium-containing dialysis, calcium-containing phosphate binders)<\/li><li><strong>Osteomalacia<\/strong>: excessive osteoid and lack of mineralization leading to &#8220;soft bones&#8221;, due to lack of vid-D<\/li><\/ul><\/li><li>Blood vessels: deposition of calcium and phosphate in vessels and fibrosis (calcium can\u2019t get incorporated into bone)<\/li><li>Ventricular hypertrophy and heart failure<\/li><li>Soft tissues: Tumoral calcinosis (calcium precipitation)<\/li><li>Dx: Alkaline-phosphatase levels, bone biopsy<\/li><li>Tx: Phosphate binders, phosphate-poor diet, calcitriol agonists<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Other complications<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Neurologic<\/li><li>Acid-base disorders<\/li><li>Hyperkalemia<\/li><li>Hypoglycemia<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Atherosclerosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Anemia<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Calcium-phosphate metabolism<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Other complications<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Atherosclerosis Atherosclerosis is a type of arteriosclerosis (stiffening of arteries) in which there&#8217;s a thickening of the intimal layer of the vessel wall due to the deposition of lipids, and sustained inflammation. By itself, atherosclerosis is both the result and the contributor to the development of CKD. CKD appears to contribute to the acceleration of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7727","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Complications of chronic kidney disease (atherosclerosis, anemia, disturbances of Ca-P metabolism) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/complications-of-chronic-kidney-disease-atherosclerosis-anaemia-disturbances-of-ca-p-metabolism\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/complications-of-chronic-kidney-disease-atherosclerosis-anaemia-disturbances-of-ca-p-metabolism\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/complications-of-chronic-kidney-disease-atherosclerosis-anaemia-disturbances-of-ca-p-metabolism\\\/\",\"name\":\"Complications of chronic kidney disease (atherosclerosis, anemia, disturbances of Ca-P metabolism) &#8211; 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