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
lack of sunlight
malabsorption-related
CKD stages 3 to 5D
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.
Differentials
- Primary hyperparathyroidism
More DifferentialsGuidelines
- Evaluation, treatment, and prevention of vitamin D deficiency
- Dietary reference intakes for calcium and vitamin D
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