Summary
Definition
History and exam
Key diagnostic factors
- features of chronic kidney disease
- features of underlying malabsorption syndrome
Other diagnostic factors
- muscle cramps and bone pain
- perioral tingling or paresthesia in fingers or toes
- Chvostek sign
- Trousseau sign
- bowed legs or knock knees
- fractures
Risk factors
- aging
- chronic kidney disease
- vitamin D deficiency: inadequate sunlight exposure
- nutritional deficiency (especially absence of dairy products and fish)
- vitamin D deficiency: malabsorption
- vitamin D deficiency: hepatic dysfunction
- vitamin D deficiency: genetic disorder
- vitamin D deficiency: obesity
- medication use
Diagnostic tests
1st tests to order
- serum calcium
- serum intact parathyroid hormone (iPTH)
- serum creatinine
- serum BUN
Tests to consider
- serum phosphorus
- serum 25-hydroxyvitamin D
- serum magnesium
- ultrasound neck
- 99Tc-sestamibi (MIBI) scan
- high-resolution contrast CT scan neck and upper chest
- MRI neck and upper chest
Treatment algorithm
lack of sunlight
malabsorption-related
CKD stages 3 to 5D
Contributors
Authors
Syazrah Salam, MBChB, PhD, FRCP
Metabolic Bone and Nephrology Consultant
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
UK
Disclosures
SS declares that he has no competing interests.
Arif Khwaja, PhD, FRCP
Consultant Nephrologist
Sheffield Kidney Institute
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
UK
Disclosures
AK declares that he has no competing interests.
Acknowledgements
Dr Arif Khwaja and Dr Syazrah Salam would like to gratefully acknowledge Dr Hugh Gallagher, Dr Louise Ross, Dr Brendan C. Stack Jr, Dr David J.A. Goldsmith, and Dr Kiran Haresh Kumar Patel, previous contributors to this topic.
Disclosures
HG, LR, BCS, DJAG, and KHKP declare that they have no competing interests.
Peer reviewers
Fong-Fu Chou, MD
Department of Surgery
Chang Gung Memorial Hospital-Kaohsiung Medical Center
Chang Gung University College of Medicine
Kaohsiung Hsien
Taiwan
Disclosures
Not disclosed.
Victor Schneider, MD
Clinical Associate Professor of Medicine
Uniformed Health Services University of the Health Sciences
Bethesda
MD
Disclosures
VS declares that he has no competing interests.
References
Key articles
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011). 2017 Jul;7(1):1-59.Full text Abstract
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.Full text Abstract
Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-22.Full text Abstract
American College of Radiology. ACR appropriateness criteria: parathyroid adenoma. 2021 [internet publication].Full text
National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Primary hyperparathyroidism
More DifferentialsGuidelines
- ACR appropriateness criteria: parathyroid adenoma
- KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)
More Guidelines
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