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Review Question - QID 683

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QID 683 (Type "683" in App Search)
You are seeing a dialysis patient for a fragility fracture. This patient also carries a diagnosis of renal osteodystrophy. What is the key pathophysiological step that is responsible for his osteomalacia?

Altered parathyoid hormone receptor sensitivity

27%

548/2056

Chronic metabolic alkalosis

4%

73/2056

Chronic imbalance of electrolytes during dialysis

4%

87/2056

Uremia related phosphate retention

59%

1219/2056

Tyrosine kinase receptor phosphorylation of the improper intracellular signalling proteins

6%

115/2056

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The key pathophysiological step in renal osteodystrophy is uremia related phosphate retention. While the pathogenesis is multifactorial, renal osteodystrophy is characterized by bone mineralization deficiency due to the electrolyte and endocrine abnormalities associated with chronic kidney disease. Hypocalcemia occurs due to the inability of the damaged kidney to convert vitamin D3 into its active form calcitriol. The damaged kidneys are also not able to adequately secrete phosphorus. This causes insoluble calcium phosphate to form in the body which removes calcium from the circulation. This leads to hypocalcemia and hence secondary hyperparathyroidism, along with hyperphosphatemia.

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