The pathophysiology of altered calcium metabolism in rhabdomyolysis-induced acute renal failure. Interactions of parathyroid hormone, 25-hydroxycholecalciferol, and 1,25-dihydroxycholecalciferol

N Engl J Med. 1981 Jul 16;305(3):117-23. doi: 10.1056/NEJM198107163050301.


We studied six oliguric patients with rhabdomyolysis-induced acute renal failure. On admission, all had marked hyperphosphatemia and hypocalcemia associated with low levels of 1,25-dihydroxycholecalciferol [1,25(OH)2D]. During the early polyuric phase, moderate hypercalcemia was accompanied by marked elevations in plasma 1,25(OH)2D and persistent elevations in parathyroid hormone (both amino and carboxy terminals). During the late polyuric phase, the levels of serum calcium and 1,25(OH)2D reverted to normal. Thus, in rhabdomyolysis-induced acute renal failure, the hypocalcemia of the oliguric phase may be secondary to decreased synthesis of 1,25(OH)2D; severe hyperphosphatemia may also have a major role. The hypercalcemia of the polyuric phase may be partly due to increased synthesis of 1,25(OH)2D, resulting from the high parathyroid hormone levels and recovery of renal function.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Adult
  • Aged
  • Alcoholic Intoxication / complications
  • Calcifediol
  • Calcitriol
  • Calcium / metabolism*
  • Dehydration / complications
  • Dihydroxycholecalciferols / blood
  • Dihydroxycholecalciferols / physiology*
  • Female
  • Humans
  • Hydroxycholecalciferols / blood
  • Hydroxycholecalciferols / physiology*
  • Hypocalcemia / etiology
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Muscular Diseases / chemically induced
  • Muscular Diseases / complications
  • Muscular Diseases / physiopathology*
  • Myoglobinuria / complications
  • Parathyroid Hormone / blood
  • Parathyroid Hormone / physiology*
  • Poisoning / complications
  • Prospective Studies


  • Dihydroxycholecalciferols
  • Hydroxycholecalciferols
  • Parathyroid Hormone
  • Calcitriol
  • Calcifediol
  • Calcium