chronic kidney disease --> decreased EPO --> decreased hematocrit chronic kidney disease --> decreased PO4- excretion --> increased PTH chronic kidney disease --> decreased 1,25 dihydrovitD (calcitriol) --> increased PTH

got it from osmosis

Finally, there’s renal osteodystrophy.

This happens for a number of reasons and it’s important to memorize all of them.

First, the kidneys can’t excrete phosphate, leading to hyperphosphatemia.

Next, the kidneys are needed to convert 25- hydroxyvitamin D to active 1,25 dihydroxyvitamin D, or calcitriol, which is the active form of vitamin D which helps with intestinal calcium reabsorption.

As a result, there will be hypocalcemia.

Now, since there’s too much phosphate and too little calcium, this can affect the bones and they can become thinner and more prone to break.

Hyperphosphatemia and hypocalcemia also triggers the parathyroid glands to release more parathyroid hormone, a hormone that causes increased bone break down to release more calcium.

Finally, the extra phosphate in the blood can also bind to calcium and they can deposit in various tissues, such as the vascular tissue.