A 68-year-old man with stage 3 CKD (eGFR 35 mL/min/1.73 m²) on lisinopril presents with fatigue. Vital signs: BP 142/88, HR 76, RR 14, temp 37°C. Labs reveal serum calcium 8.2 mg/dL, phosphate 4.8 mg/dL, PTH 120 pg/mL, and 25-OH vitamin D 22 ng/mL. Urinalysis is unremarkable. Which of the following is the most appropriate initial management?
- A)Parathyroidectomy
- B)Acute hemodialysis
- C)Vitamin D supplementation and phosphate bindersGABARITO
- D)Calcitonin injection
- E)Calcium supplementation alone
Explicação
This patient has secondary hyperparathyroidism early in renal disease (stage 3). Initial management includes vitamin D supplementation (ergocalciferol or calcitriol), phosphate-binding agents, and dietary phosphate restriction to slow parathyroid hyperplasia a... Ver explicação completa e trilha adaptativa →