Following up on an earlier query regarding PTH level in CKD stage 3 for my son. His PTH level (117) continues to be elevated but calcium (9), phosphorus (3.5), viatmin d (32) level are all within range. And he is overall doing well. The Nephrologist has now recommended calcitrol/active vitamin d. In your earlier reply you had suggested that this should be done if he advances to stage 4 or 5. I am wondering if he should be taking this now as his egfr has actually further improved since his last results 4 months back. Need your guidance. Are there any serious side effects of taking this medication? Can he instead do dietary control?.

As I mentioned before, management of mineral and bone disorders (MBD) is very complex.  I am not able to provide treatment advice without performing a complete history and physical examination on your son.  Treatment options include active vitamin D and other drugs known as calcium receptor agonists (cinacalcet).  It is also important to consider trends in parathyroid hormone measurements and levels of bone enzymes in the blood such as alkaline phosphatase.  Hence, because it is very complex, I recommend that you follow the recommendations of the nephrologist caring for your son.

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