A 60 year old male was diagnosed with end stage kidney disease 5 years ago & has been managed with hemodialysis since then. He is also hypeensive & diabetic. He is not compliant with his medications & hemodialysis schedule & now presented with bone pain & dyspnea. CXR shows hazy bilateral infiltrates. Chest CT shows ground-glass infiltrates bilaterally. Lab studies show elevated levels of calcium & phosphate, PTH levels of 130 pg/ml. What would be the best management for this patient?
Given scenario suggests the diagnosis of teiary hyperparathyroidism- commonly seen in patients with chronic kidney disease who are poorly compliant with therapy. Features- bone pain, ectopic calcification & pruritus. Hypoxemia and ground-glass infiltrates on chest CT represent ectopic calcification of the lungs. A technetium-99 bone scan will show increased uptake in the lungs. Lab- Elevated calcium, phosphates & PTH levels Rx- Parathyroidectomy is done in this patient because of severe clinical manifestations.
Calcitriol 0.5 mg IV with hemodialysis with sevelamer three times daily
Calcitriol 0.5 mg orally daily with sevelamer 1600 mg three times daily
More aggressive hemodialysis to achieve optimal fluid and electrolyte balance
Parathyroidectomy
Disorders of Parathyroid Gland