The other side of vitamin D therapy:  a case series of acute kidney injury due to malpractice-related vitamin D intoxication

Wani, Muzafar M; Wani, Imtiaz; Banday, K A; Ashraf, Mohd

doi:10.5414/cn108904

Cited by 26 publications

(18 citation statements)

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“…Worryingly, there have been a number of case reports on the mistaken administration of high doses of vitamin D to children by parents, resulting in hospitalization with severe toxicity [47,48]. Vitamin D toxicity following excessive replacement by the medical community with prolonged high doses of vitamin D has also been reported [44,45,[49][50][51][52][53][54]. All of these patients had been treated injudiciously with high doses of parenteral vitamin D, and all had been receiving vitamin D treatment under medical supervision.…”

Section: Causes Of Vitamin D Toxicitymentioning

confidence: 99%

A review of the growing risk of vitamin D toxicity from inappropriate practice

Taylor

Davies

2018

Brit J Clinical Pharma

140

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Vitamin D is a particularly important sterol hormone, with evidence emerging of its beneficial effects well beyond bone. In consequence of this and increased global recognition of vitamin D deficiency in the general population, there has been a resurgence in treatment with vitamin D preparations. However, the increasing use of vitamin D treatments has also seen a substantial increase in the number of reports of vitamin D intoxication, with the majority (75%) of reports published since 2010. Many of these cases are a consequence of inappropriate prescribing, and the use of high-dose over-the-counter preparations or unlicensed preparations. This review highlights that the majority of cases were preventable and discusses the inappropriate use of poorly formulated, and unlicensed vitamin D preparations.

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Section: Causes Of Vitamin D Toxicitymentioning

confidence: 99%

A review of the growing risk of vitamin D toxicity from inappropriate practice

Taylor

Davies

2018

Brit J Clinical Pharma

140

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“…Hypercalcemia following vitamin D intoxication may occur due to incorrect prescriptions or accidental overdosing . For example, in the summer of 2016, >70 children were reported to have developed hypercalcemia after receiving a vitamin D preparation that contained 75 times higher levels than those recommended .…”

Section: Pth‐independent Hypercalcemiamentioning

confidence: 99%

“…Hypercalcemia following vitamin D intoxication may occur due to incorrect prescriptions or accidental overdosing. (11)(12)(13)(14) For Fig. 1.…”

Section: Hypercalcemia Associated With High Plasma 25(oh)d 3 Concentrmentioning

confidence: 99%

Hypercalcemic Disorders in Children

Stokes

Nielsen

Hannan

et al. 2017

Journal of Bone and Mineral Research

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Hypercalcemia is defined as a serum calcium concentration that is greater than two standard deviations above the normal mean, which in children may vary with age and sex, reflecting changes in the normal physiology at each developmental stage. Hypercalcemic disorders in children may present with hypotonia, poor feeding, vomiting, constipation, abdominal pain, lethargy, polyuria, dehydration, failure to thrive, and seizures. In severe cases renal failure, pancreatitis and reduced consciousness may also occur and older children and adolescents may present with psychiatric symptoms. The causes of hypercalcemia in children can be classified as parathyroid hormone (PTH)‐dependent or PTH‐independent, and may be congenital or acquired. PTH‐independent hypercalcemia, ie, hypercalcemia associated with a suppressed PTH, is commoner in children than PTH‐dependent hypercalcemia. Acquired causes of PTH‐independent hypercalcemia in children include hypervitaminosis; granulomatous disorders, and endocrinopathies. Congenital syndromes associated with PTH‐independent hypercalcemia include idiopathic infantile hypercalcemia (IIH), William's syndrome, and inborn errors of metabolism. PTH‐dependent hypercalcemia is usually caused by parathyroid tumors, which may give rise to primary hyperparathyroidism (PHPT) or tertiary hyperparathyroidism, which usually arises in association with chronic renal failure and in the treatment of hypophosphatemic rickets. Acquired causes of PTH‐dependent hypercalcemia in neonates include maternal hypocalcemia and extracorporeal membrane oxygenation. PHPT usually occurs as an isolated nonsyndromic and nonhereditary endocrinopathy, but may also occur as a hereditary hypercalcemic disorder such as familial hypocalciuric hypercalcemia, neonatal severe primary hyperparathyroidism, and familial isolated primary hyperparathyroidism, and less commonly, as part of inherited complex syndromic disorders such as multiple endocrine neoplasia (MEN). Advances in identifying the genetic causes have resulted in increased understanding of the underlying biological pathways and improvements in diagnosis. The management of symptomatic hypercalcemia includes interventions such as fluids, antiresorptive medications, and parathyroid surgery. This article presents a clinical, biochemical, and genetic approach to investigating the causes of pediatric hypercalcemia. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

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“…Therefore, as a surrogate marker of diabetic kidney disease progression, the augmentation in exocytosis-mediated urinary megalin excretion creates a vicious cycle of tubular damage and may also contribute to higher values of albuminuria found in VitD 3 -treated ob/ob mice. Other possible mechanisms include acute hypercalcemia induced by VitD 3 toxicity, which may lead to acute kidney injury by decreasing extracellular fluid volume due to anorexia, nausea, vomiting, and decreased ability to concentrate urine, besides a direct renal vasoconstriction effect, as observed in VitD 3 -treated animals from our protocol, and in vitamin D intoxication in humans 13 . VitD 3 effects are mediated by VDR.…”

Section: 26mentioning

confidence: 94%

Excessive cholecalciferol supplementation increases kidney dysfunction associated with intrarenal artery calcification in obese insulin-resistant mice

Almeida

Fessel

Carmo

et al. 2020

Sci Rep

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Diabetes mellitus accelerates vascular calcification (VC) and increases the risk of end-stage renal disease (ESRD). Nevertheless, the impact of VC in renal disease progression in type 2 diabetes mellitus (T2DM) is poorly understood. We addressed the effect of VC and mechanisms involved in renal dysfunction in a murine model of insulin resistance and obesity (ob/ob), comparing with their healthy littermates (C57BL/6). We analyzed VC and renal function in both mouse strains after challenging them with Vitamin D 3 (VitD 3). Although VitD 3 similarly increased serum calcium and induced bone disease in both strains, 24-hour urine volume and creatinine pronouncedly decreased only in ob/ob mice. Moreover, ob/ob increased urinary albumin/creatinine ratio (ACR), indicating kidney dysfunction. In parallel, ob/ob developed extensive intrarenal Vc after VitD 3. coincidently with increased intrarenal vascular mineralization, our results demonstrated that Bone Morphogenetic Protein-2 (BMP-2) was highly expressed in these arteries exclusively in ob/ob. these data depict a greater susceptibility of ob/ob mice to develop renal disease after VitD 3 in comparison to paired C57BL/6. In conclusion, this study unfolds novel mechanisms of progressive renal dysfunction in diabetes mellitus (DM) after VitD 3 in vivo associated with increased intrarenal VC and highlights possible harmful effects of long-term supplementation of VitD 3 in this population. Vascular calcification (VC) is a pathological condition which causes loss of arterial elasticity and augments vascular stiffening associated with increased cardiac work 1,2. This contributes to several cardiovascular diseases such as systemic arterial hypertension, coronary artery and cerebrovascular disease, congestive heart failure, and end-stage renal disease (ESRD) 3. Previously thought as a process of physiological aging, VC is currently known as an active and complex process, characterized by increased calcifying signaling agonists that overcome inhibitory mediators and resembles skeleton ossification 1,2. Diabetes mellitus is a huge public health problem in the world. It is estimated that diabetic population will reach 430 million people in 2030. Incidence of ESRD is up to 10 times as high in adults with diabetes as those without 4. ESRD attributable to diabetes is 12-55% 4. In the last decades, numerous advances have been incorporated to the treatment of ESRD. However, the incidence of renal replacement therapy and mortality rates in this population remains high 5,6. Epidemiological studies describe ESRD and VC as independent cardiovascular risk factors 5. However, ESRD patients are usually identified with VC 7,8 , and ESRD together with diabetes mellitus accelerates VC progression 7-9 .

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The other side of vitamin D therapy:  a case series of acute kidney injury due to malpractice-related vitamin D intoxication

Abstract: This is the largest case series of AKI secondary to vitamin D toxicity ever reported. .

Cited by 26 publications

References 0 publications

A review of the growing risk of vitamin D toxicity from inappropriate practice

A review of the growing risk of vitamin D toxicity from inappropriate practice

Hypercalcemic Disorders in Children

Excessive cholecalciferol supplementation increases kidney dysfunction associated with intrarenal artery calcification in obese insulin-resistant mice

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The other side of vitamin D therapy: a case series of acute kidney injury due to malpractice-related vitamin D intoxication

Abstract: This is the largest case series of AKI secondary to vitamin D toxicity ever reported. .

Cited by 26 publications

References 0 publications

A review of the growing risk of vitamin D toxicity from inappropriate practice

A review of the growing risk of vitamin D toxicity from inappropriate practice

Hypercalcemic Disorders in Children

Excessive cholecalciferol supplementation increases kidney dysfunction associated with intrarenal artery calcification in obese insulin-resistant mice

Contact Info

Product

Resources

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The other side of vitamin D therapy:  a case series of acute kidney injury due to malpractice-related vitamin D intoxication

Abstract: This is the largest case series of AKI secondary to vitamin D toxicity ever reported. .