Summary
Definition
History and exam
Key diagnostic factors
- features of chronic renal failure
- 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 renal failure
- 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
Consultant Nephrologist
Honorary Senior Lecturer
Renal Medicine
Epsom & St Helier University Hospitals NHS Trust
UK
Disclosures
HG declares that he has no competing interests.
Clinical Research Fellow & Specialist Renal Registrar
Renal Medicine
Epsom & St Helier University Hospitals NHS Trust
UK
Disclosures
LR declares that she has no competing interests.
Dr Hugh Gallagher and Dr Louise Ross would like to gratefully acknowledge Dr Brendan C. Stack Jr, Dr David J.A. Goldsmith, and Dr Kiran Haresh Kumar Patel, previous contributors to this monograph. BCS, DJAG, and KHKP declare that they have no competing interests.
Peer reviewers
Department of Surgery
Chang Gung Memorial Hospital-Kaohsiung Medical Center
Chang Gung University College of Medicine
Kaohsiung Hsien
Taiwan
Disclosures
Not disclosed.
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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