Abstract: PUB248
Chronic Hypoparathyroidism: Four Cases Highlighting Severe Complications and Room for Improvement
Session Information
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Author
- Vazquez Gomez, Carmen, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, GA, Spain
Introduction
Chronic hypoparathyroidism is a rare disorder usually treated with lifelong calcium and active vitamin D. This non-physiological approach may fail to prevent long-term complications, mainly renal damage, and favors therapeutic inertia. We describe four patients from a general nephrology clinic to highlight severity, renal/neurological involvement and opportunities for improvement
Case Description
Four patients with chronic hypoparathyroidism were reviewed. The series included severe manifestations such as chronic kidney disease, hypercalciuria, nephrolithiasis/nephrocalcinosis and neurological calcifications compatible with Fahr syndrome. Two patients met criteria for treatment with palopegteriparatide because of renal involvement. The first had bilateral nephrolithiasis, including a staghorn calculus pending combined endoscopic intrarenal surgery, persistent hypercalciuria despite hypocalcaemia, serum calcium 7.4 mg/dL, and CKD G2A1. The second had CKD G3aA1 after a previous episode of hypercalcaemia, with an estimated glomerular filtration rate of 33.2 mL/min in September 2025. After starting palopegteriparatide, both patients achieved normocalcaemia without oral calcium or active vitamin D and reported clinical improvement. Hypercalciuria decreased, and renal function improved significantly in one patient. Mild hypercalcaemia in one case resolved after reducing the dose from 18 to 15 mcg/day subcutaneously.
Discussion
These cases show that chronic hypoparathyroidism is not merely a biochemical disorder. It may lead to severe renal disease, nephrolithiasis, ectopic calcifications and neurological complications such as Fahr syndrome. Regular assessment should include serum calcium/phosphate, urinary calcium, eGFR and renal imaging, since hypercalciuria may occur despite normal or low serum calcium. In selected patients with inadequate control, palopegteriparatide offers a more physiological option and may reduce dependence on conventional therapy. Earlier recognition, structured follow-up and timely treatment escalation may prevent avoidable complications and improve quality of life.