Chapter 34: Acute Kidney Injury and Chronic Kidney Disease

The material explores how progressive loss of kidney function triggers cascading metabolic disturbances that affect multiple organ systems, with particular emphasis on the skeletal and cardiovascular complications that develop in advanced renal dysfunction. A central focus addresses chronic kidney disease-mineral bone disease, a metabolic disorder characterized by abnormalities in calcium, phosphate, and parathyroid hormone regulation that leads to bone pathology and vascular calcification. The chapter discusses how secondary hyperparathyroidism develops in response to renal phosphate retention and impaired conversion of vitamin D to its active form, perpetuating a cycle of bone resorption and mineral dysregulation. Adynamic bone disease represents a specific form of skeletal pathology common in dialysis patients, characterized by suppressed bone turnover that paradoxically increases fracture risk despite reduced bone remodeling. The content covers therapeutic interventions designed to modulate bone metabolism and mineral homeostasis, including calcimimetic agents that suppress parathyroid hormone secretion, phosphate binders that reduce intestinal phosphate absorption, and bone-active medications such as parathyroid hormone analogs that can stimulate bone formation. The chapter integrates discussion of how mineral bone disease contributes to accelerated cardiovascular disease in kidney disease patients, linking skeletal pathology to increased risk of vascular calcification, left ventricular hypertrophy, and sudden cardiac events. Management strategies emphasize the importance of early detection and intervention to prevent progression of bone disease and reduce cardiovascular morbidity and mortality in patients with declining renal function.