Consequences of Hyperphosphatemia: Are We Accepting the Unacceptable?

University of Minnesota
CME Internet Program

Posttest

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  1. A low-phosphorus diet improves patient outcomes by which of the following mechanisms?
  1. Low serum phosphorus induces apoptosis of the hyperplastic parathyroid gland, reducing the size of the gland.
  2. The number of calcium receptors in the parathyroid glands decreases when serum phosphorus is low.
  3. Maintaining serum phosphorus in the normal physiologic range permits the use of vitamin D analogs to control PTH secretion.
  4. A low-phosphorus diet acts as a mitogenic signal to increase cell division in the parathyroid gland.
  1. To achieve improved patient outcomes, what should the optimal range of Ca x P be?
  1. 35-50 mg2 x dL2
  2. 50-60 mg2 x dL2
  3. 60-70 mg2 x dL2
  4. >70 mg2 x dL2
  1. What is the mechanism of chronic calcium ion loss from bone during metabolic acidosis?
  1. Low pH results in an uptake of hydrogen into bone, with a simultaneous loss of calcium.
  2. Under conditions of acidosis, osteoclast activity is stimulated, whereas osteoblast activity is inhibitied.
  3. Collagen synthesis is decreased by low pH, resulting in lower bone formation.
  4. All of the above.
  1. In metabolic acidosis:
  1. Potassium and calcium are lost from bone, whereas sodium and hydrogen are taken up by bone.
  2. Calcium and hydrogen are lost from bone, whereas carbonate and phosphate are taken up by bone.
  3. Several positive and negative ions are lost from bone, disturbing the ability of the bone to buffer excess hydrogen ions.
  4. Negative ions interact with excess hydrogen and are taken up by bone.
  1. Which of the following are helpful in limiting the effects of hyperphosphatemia and hyperparathyroidism?
  1. vitamin D analogs
  2. novel phosphate binders
  3. calcimimetics
  4. all of the above

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