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 3. 某位 CKD stage 5 的病人，[Ca] 8.7 mg/dL, [P] 6.8 mg/dL。 下列有關腎性骨病變的敘述，何者不正確?
(A) Hyperphosphatemia stimulates increasing plasma level of PTH (parathyroid hormone)
(B) Low serum [Ca] level, and reduced FGF-23 (fibroblast growth factor 23)production contribute to renal bone disease
(C) Nephron loss reduces synthesis of 1,25-Vitamin D3
(D)Low level of 1,25-Vitamin D3 results in lower intestine resorption of Ca

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 【站僕】摩檸Morning：有沒有達人來解釋一下?
倒數 1天 ,已有 1 則答案
. 大三上 (2021/05/22):

B: increase FGF-23


FGF-23 is part of a family of phosphatonins that promotes renal phosphate excretion. FGF-23, secreted by osteocytes, increase early in the course of CKD, even before phosphate retention and hyperphosphatemia. FGF-23 may defend normal serum phosphorus in at least three ways: (1) increased renal phosphate excretion; (2) stimulation of PTH, which also increases renal phosphate excretion; and (3) suppression of the formation of 1,25(OH)2D3, leading to diminished phosphorus absorption from the GI tract. Interestingly, high levels of FGF-23 are also an independent risk factor for left ventricular hypertrophy and mortality in CKD, dialysis, and kidney transplant  patients. Moreover, elevated levels of FGF-23 may indicate the need for therapeutic intervention (e.g., phosphate restriction), even when serum phosphate levels are within the normal range.

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 3. 某位 CKD stage 5 的病人，[Ca] 8.7 mg/dL, [..-阿摩線上測驗