Question:
A 5-year-old child with known chronic kidney disease presents with bowing of the legs. Lab results reveal normal calcium, elevated phosphate, increased alkaline phosphatase, and low 25(OH) Vitamin D. What is the most appropriate next intervention?
A 5-year-old child with known chronic kidney disease presents with bowing of the legs. Lab results reveal normal calcium, elevated phosphate, increased alkaline phosphatase, and low 25(OH) Vitamin D. What is the most appropriate next intervention?
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CKD with rickets-like bone changes and high phosphate = treat with phosphate binder and calcium/vitamin D correction.
Updated On: May 14, 2026
- Calcium supplementation with phosphate binder
- Phosphate binder
- Oral calcium with Vitamin D
- Growth hormone therapy
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The Correct Option is A
Solution and Explanation
Concept:
Chronic kidney disease can cause renal osteodystrophy due to phosphate retention, vitamin D deficiency, and secondary hyperparathyroidism. Management includes correction of calcium-vitamin D balance and control of hyperphosphatemia.
Step 1: Identify the bone disorder.
The child has CKD with bowing of legs, suggesting renal rickets or renal osteodystrophy.
Step 2: Interpret lab findings.
The findings are: \[ \text{Elevated phosphate + increased ALP + low Vitamin D} \] This supports abnormal bone mineral metabolism in CKD.
Step 3: Choose management.
The child needs phosphate control and calcium support: \[ \text{Calcium supplementation with phosphate binder} \] Therefore, the correct answer is Calcium supplementation with phosphate binder.
Step 1: Identify the bone disorder.
The child has CKD with bowing of legs, suggesting renal rickets or renal osteodystrophy.
Step 2: Interpret lab findings.
The findings are: \[ \text{Elevated phosphate + increased ALP + low Vitamin D} \] This supports abnormal bone mineral metabolism in CKD.
Step 3: Choose management.
The child needs phosphate control and calcium support: \[ \text{Calcium supplementation with phosphate binder} \] Therefore, the correct answer is Calcium supplementation with phosphate binder.
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