Nephrology: CKD mineral and bone disorder: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: CKD mineral and bone disorder

Sample item

A 55-year-old man on maintenance haemodialysis has serum phosphate 7.8 mg/dL, corrected calcium 10.9 mg/dL and coronary artery calcification on CT. Dietary phosphate restriction is already in place. Which phosphate binder is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Sevelamer

Calcium-containing binders add to the calcium load and promote vascular calcification, so a non-calcium binder such as sevelamer is preferred when calcium is high or calcification is present. Aluminium is avoided long term because it causes bone disease and encephalopathy. Calcitriol raises gut phosphate absorption.

Option by option

  • A. Long-term aluminium hydroxide

    Aluminium accumulates in renal failure, causing osteomalacia and dementia, so it is avoided for long-term use.

  • B. Sevelamer (correct)

    Correct. Sevelamer binds phosphate without adding calcium.

  • C. Calcium carbonate

    Calcium carbonate would worsen hypercalcaemia and vascular calcification.

  • D. Calcitriol

    Calcitriol is a vitamin D analogue that increases phosphate and calcium absorption, so it would worsen both.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Sevelamer. Calcium-containing binders add to the calcium load and promote vascular calcification, so a non-calcium binder such as sevelamer is preferred when calcium is high or calcification is present.

Why is "Long-term aluminium hydroxide" not the answer?

Aluminium accumulates in renal failure, causing osteomalacia and dementia, so it is avoided for long-term use.

Why is "Calcium carbonate" not the answer?

Calcium carbonate would worsen hypercalcaemia and vascular calcification.

Why is "Calcitriol" not the answer?

Calcitriol is a vitamin D analogue that increases phosphate and calcium absorption, so it would worsen both.

What concept does this question test?

It tests Nephrology: CKD mineral and bone disorder in General Medicine. Aluminium is avoided long term because it causes bone disease and encephalopathy. Calcitriol raises gut phosphate absorption.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: CKD mineral and bone disorder?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.