Sample interview questions: How do you approach the management of patients with endocrine complications of kidney disease in children?
Sample answer:
Comprehensive Management of Endocrine Complications in Pediatric Kidney Disease
Assessment:
- Thorough history and physical examination, including relevant family history
- Laboratory evaluation: electrolytes, creatinine, urea nitrogen, hormone levels (PTH, vitamin D, calcium, phosphate)
- Imaging studies: renal ultrasound, abdomen X-ray
Management Strategies:
1. Hyperparathyroidism (Secondary):
* Aim: Control elevated PTH levels and prevent skeletal deformities
* Medications:
* Calcitriol (active vitamin D): Increases calcium absorption and suppresses PTH production
* Cinacalcet: Blocks calcium-sensing receptors in the parathyroid glands, reducing PTH secretion
* Parathyroidectomy: Surgical removal of enlarged parathyroid glands
2. Hypocalcemia:
* Aim: Maintain calcium homeostasis and prevent bone loss
* Medications:
* Calcium supplements
* Calcitriol
* Dietary modifications: Increase calcium intake from food sources
3. Hyperphosphatemia:
* Aim: Reduce serum phosphate levels and prevent soft tissue calcification
* Medications:
* Phosphate binders: Lanthanum carbonate, sevelamer carbonate
* Low-phosphate diet
* Dialysis: Hemodialysis or peritoneal dialysis can remove excess phosphate
4. Rickets and Osteomalacia:
* Aim: Correct skeletal deformities and mineralization defects
* Medications:
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