小结
定义
病史和体格检查
关键诊断因素
- features of chronic kidney disease
- features of underlying malabsorption syndrome
其他诊断因素
- muscle cramps and bone pain
- perioral tingling or paresthesia in fingers or toes
- Chvostek sign
- Trousseau sign
- bowed legs or knock knees
- fractures
危险因素
- 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
诊断性检查
首要检查
- serum calcium
- serum intact parathyroid hormone (iPTH)
- serum creatinine
- serum BUN
需考虑的检查
- 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
治疗流程
lack of sunlight
malabsorption-related
CKD stages 3 to 5D
撰稿人
作者
Syazrah Salam, MBChB, PhD, FRCP
Metabolic Bone and Nephrology Consultant
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
UK
利益声明
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
利益声明
AK declares that he has no competing interests.
鸣谢
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.
利益声明
HG, LR, BCS, DJAG, and KHKP declare that they have no competing interests.
同行评议者
Fong-Fu Chou, MD
Department of Surgery
Chang Gung Memorial Hospital-Kaohsiung Medical Center
Chang Gung University College of Medicine
Kaohsiung Hsien
Taiwan
Раскрытие информации
Not disclosed.
Victor Schneider, MD
Clinical Associate Professor of Medicine
Uniformed Health Services University of the Health Sciences
Bethesda
MD
Раскрытие информации
VS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
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.Полный текст Аннотация
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.Полный текст Аннотация
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.Полный текст Аннотация
American College of Radiology. ACR appropriateness criteria: parathyroid adenoma. 2021 [internet publication].Полный текст
National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].Полный текст
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Primary hyperparathyroidism
Больше 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)
Больше Guidelines
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