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23 Aug 2018

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Keith Leannon
Keith LeannonLv2
23 Aug 2018

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Provide data pertaining to the morbidity and mortality rates for chronic kidney disease in African Americans.

A 58-year-old obese woman with hypertension, type 2 diabetes, and chronic kidney disease is admitted to hospital after a right femoral neck fracture sustained in a fall. Recently, she has been complaining of fatigue and was started on epoetin alfa (erythropoietin) subcutaneous injections. Her other medications include an angiotensin-converting enzyme inhibitor, a β-blocker, a diuretic, calcium supplementation, and insulin. On review of systems, she reports mild tingling in her lower extremities. On examination, her blood pressure is 148/60 mm Hg. She is oriented and able to answer questions appropriately. There is no evidence of jugular venous distention or pericardial friction rub. Analyze this case study and answer the next two questions that follow.

Which of the following is true of the pathogenesis of bone disease in chronic kidney disease? (select all that apply)

In this patient, calcium is poorly absorbed from the gut because of decreased renally generated vitamin 1,25-(OH)2 D3 levels.
In this patient, hypocalcemia results and is further exacerbated by high serum phosphate levels from impaired phosphate excretion by the kidney.
This patient probably suffers from osteoporosis, accelerated by her underlying renal failure. The pathogenesis of bone disease is multifactorial.
In this patient, low serum calcium and hyperphosphatemia trigger PTH secretion, which depletes bone calcium and contributes to osteomalacia and osteoporosis.

Why was erythropoietin therapy initiated? (select all that apply)

This treatment is indicated for this patient because of impaired synthesis of erythropoietin by the kidney and thus decreased erythropoiesis.
This treatment is used to treat diabetes.
This treatment is used to treat bone fracture.
This treatment is used to treat anemia seen in chronic kidney disease.

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