Osteomalacia and secondary hyperparathyroidism after kidney transplantation

relationship to vitamin D deficiency

Hassan Amin, Barry Wall, C. Robert Cooke

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Secondary hyperparathyroidism is highly prevalent in patients with end-stage renal disease. After successful kidney transplantation, however, parathyroid glands gradually involute to normal size with subsequent normalization of intact parathyroid hormone (PTH), serum calcium, and phosphorous concentrations. This report describes a 48-year-old diabetic end-stage renal disease patient who underwent a successful cadaveric kidney transplant. Serum calcium and phosphorous concentrations normalized within 6 months. Three years later, he presented with complaints of proximal muscle weakness that was progressively worsening. Physical examination revealed temporal wasting and proximal muscle weakness. Detailed neurologic examination was unremarkable except for decreased vibratory sensation in both feet. Laboratory data showed stable allograft function (serum creatinine, 1.3 mg/dL), hypocalcemia, and hypophosphatemia with markedly elevated alkaline phosphatase level (726 IU/L) and intact PTH level (947 pg/mL). Further laboratory evaluation revealed poor nutritional status and severe deficiency of 25(OH)D (4.0 ng/mL). Past medical history included remote episodes of acute pancreatitis due to prior alcohol abuse. Computed tomography of the abdomen showed calcific atrophic pancreas, and steatorrhea was confirmed on stool studies. Decreased bone mineral density was noted by computed tomography bone density scan. Secondary hyperparathyroidism and osteomalacia had developed due to severe vitamin D deficiency, occurring as a result of previously unrecognized, minimally symptomatic pancreatic exocrine insufficiency. Treatment with vitamin D, calcium, and pancreatic enzyme replacement led to remarkable resolution of clinical symptoms and secondary hyperparathyroidism (intact PTH, 65 pg/mL after therapy) and resulted in significant improvement in bone mineralization. Factors associated with vitamin D deficiency in the chronic kidney disease and post-transplant patient population are reviewed.

Original languageEnglish (US)
Pages (from-to)58-62
Number of pages5
JournalAmerican Journal of the Medical Sciences
Volume333
Issue number1
DOIs
StatePublished - Jan 1 2007

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Osteomalacia
Secondary Hyperparathyroidism
Vitamin D Deficiency
Parathyroid Hormone
Kidney Transplantation
Muscle Weakness
Calcium
Bone Density
Chronic Kidney Failure
Serum
Tomography
Steatorrhea
Hypophosphatemia
Exocrine Pancreatic Insufficiency
Transplants
Physiologic Calcification
Parathyroid Glands
Hypocalcemia
Neurologic Examination
Nutritional Status

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Osteomalacia and secondary hyperparathyroidism after kidney transplantation : relationship to vitamin D deficiency. / Amin, Hassan; Wall, Barry; Cooke, C. Robert.

In: American Journal of the Medical Sciences, Vol. 333, No. 1, 01.01.2007, p. 58-62.

Research output: Contribution to journalArticle

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