Last reviewed: 6 Nov 2021
Last updated: 27 Aug 2021

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 investigations

1st investigations to order

  • serum calcium
  • serum intact parathyroid hormone (iPTH)
  • serum creatinine
  • serum BUN

Investigations to consider

  • serum phosphorus
  • serum 25-hydroxyvitamin D
  • serum magnesium
  • ultrasound neck
  • sestamibi scan
  • high-resolution contrast CT scan neck and upper chest
  • MRI neck and upper chest

Treatment algorithm

Contributors

Authors

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.

Syazrah Salam, MBChB MRCP PhD

Renal Registrar

Sheffield Kidney Institute

Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust

UK

Disclosures

SS has received a research grant from Immunodiagnostic Systems via the University of Sheffield. SS is an author of an article cited in this topic.

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.

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