Hypercalcemia: a consultant’s approach


Due to their daily involvement in mineral metabolism, nephrologists are often asked to consult on children with hypercalcemia. This might become even more pertinent when the hypercalcemia is associated with acute kidney injury and/or hypercalciuria and renal calcifications. The best way to assess the severity of hypercalcemia is by measurement of plasma ionized calcium, and if not available by adjusting serum total calcium to albumin concentration. The differential diagnosis of the possible etiologies of the disturbance in the mineral homeostasis starts with the assessment of serum parathyroid hormone concentration, followed by that of vitamin D metabolites in search of both genetic and acquired etiologies. Several tools are available to acutely treat hypercalcemia with the current main components being fluids, loop diuretics, and antiresorptive agents. This review will address the pathophysiologic mechanisms, clinical manifestations, and treatment modalities involved in hypercalcemia.

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We would like to thank Ms. Andrea Fontana for her administrative assistance. This work was supported by the Sam and Helen Kaplan Research Fund in Pediatric Nephrology and the Eric McClure Research Fund in Bone and Mineral Metabolism.

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Correspondence to Uri S. Alon.

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Auron, A., Alon, U.S. Hypercalcemia: a consultant’s approach. Pediatr Nephrol 33, 1475–1488 (2018). https://doi.org/10.1007/s00467-017-3788-z

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  • Acute kidney injury
  • Parathyroid hormone
  • PTH-related peptide
  • Vitamin D
  • Calcitriol
  • Bisphosphonates