Chronic renal insufficiency:
1) poor phosphate clearance --> high serum inorganic phosphorous
2) high serum phosphate --> complexes with divalent cation Ca --> Ca falls
3) Ca falls --> triggers PTH axis
4) kidney failure --> decreased activity of 1-hydroxylase at the kidney --> less calcitriol
Since she has celiac spruce --> fat vitamin malabsorption, thus Vit. D is decreased Low vit. D = low calcitriol, low absorption of phosphate from intestine, and low absorption of Ca2+ causing an increase PTH
to snoo-finity ... and beyond!
submitted by bubbles(31), 2019-06-08T22:13:17Z
Chronic renal insufficiency:
1) poor phosphate clearance --> high serum inorganic phosphorous
2) high serum phosphate --> complexes with divalent cation Ca --> Ca falls
3) Ca falls --> triggers PTH axis
4) kidney failure --> decreased activity of 1-hydroxylase at the kidney --> less calcitriol