Mineral and bone disorders in chronic kidney disease

Abstract

A 64-year-old woman with a history of chronic kidney disease (CKD) Stage 4 [estimated glomerular filtration rate (eGFR) of 17 cc/min/1.73 mm 2 ] is referred for evaluation of poor kidney function. Over the last month she has complained of itching, skin eruptions on her arms and back, and nonspecific bone pain. She has been unable to sleep at night and denies changes in soap, laundry detergent, or perfume. She has never been prescribed a phosphate binder or vitamin D, has no dietary restrictions, and dines out a few times per week. She usually consumes bacon and eggs for breakfast, a sandwich with cheese and cold cuts for lunch, and beans and chicken or fish for dinner. She has never been to see a nutritionist but feels her dietary intake is adequate. Physical exam is remarkable for diffuse areas of excoriation on her arms and back with raised hard central pustules. Pertinent laboratory values: phosphorous-7.5 mg/dL, calcium-7.9 g/dL, albumin-4 g/dL, creatinine-3.5 mg/dL, urea-50 mg/dL, alkaline phosphatase-180 mg/dL, bicarbonate-20 mEq/L. Intact PTH and vitamin D 25 are pending at the end of her visit.