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Parathyroid/Calcium Disorders and Kidney Problems

Online Health Chat with Susan Williams, MD, and Juan Calle, MD

June 27, 2014

Description

Calcium is an important mineral that is needed by the body to function properly. Vitamin D and parathyroid hormone help to regulate the level of calcium absorbed by the body and eliminated by the kidneys. Calcium recommendations for those with chronic kidney disease (CKD) are different than those for the healthy population, and an increase in parathyroid hormone (PTH) is commonly seen in those with kidney failure.

Parathyroid disorders affecting the calcium level include hypercalcemia, hypocalcemia, hyperparathyroidism (primary, secondary or tertiary), hypoparathyroidism and parathyroid cancer. Almost 100,000 Americans develop primary hyperparathyroidism each year, with women more likely to develop benign adenomas—particularly after menopause—than men. Although too much calcium may not cause any symptoms, some may experience:

  • Depression or mental confusion
  • Kidney stones
  • Bone and joint pain
  • Abdominal pain
  • General aches and pains from no obvious cause

Diagnosis of parathyroid conditions is completed through ultrasound, Tc-sestamibi scan, CT and MRI. Mild hyperparathyroidism may be treated with hormone replacement therapy or medications. The usual treatment for hyperparathyroidism is surgery.


About the Speakers

Susan Williams, MD, is a specialist in Cleveland Clinic’s Endocrine Calcium Clinic and a staff physician in the Endocrinology & Metabolism Institute. She is board certified in internal medicine and is certified by the American Board of Obesity Medicine and American Board of Physician Nutrition Specialists as a Physician Nutrition Specialist.

Dr. Williams completed her fellowship in clinical nutrition and metabolism at Cleveland Clinic. She completed her residency in internal medicine at Kettering Medical Center in Kettering, Ohio. She is a graduate of the Wright State University School of Medicine, in Dayton, Ohio. Dr. Williams obtained her Master’s degree in human and clinical nutrition from the University of Rhode Island, in Kingston, RI. She completed the U.S. Air Force internship in clinical nutrition and served as an officer, nutrition professional and reservist in the U.S. Air Force. Dr. William’s specialty interests include bone and mineral metabolism, metabolic bone disease, calcium disorders, malabsorption and malnutrition in adults, and medical bariatrics.

Juan Calle, MD, is co-director of Cleveland Clinic’s Kidney Stone Clinic and a board-certified nephrologist in Cleveland Clinic’s Department of Nephrology and Hypertension at Glickman Urological & Kidney Institute. Dr. Calle completed his fellowship in nephrology and hypertension at Mayo Clinic in Rochester, Minn. He completed his residency in internal medicine at Mount Sinai Medical Center in Miami Beach, Fla, after medical school at the Instituto de Ciencias de la Salud CES in Medelin/Antioquia, Colombia. Dr. Calle’s specialty interests include kidney stones, hypertension and glomerulonephritis.


Let’s Chat About Parathyroid/Calcium Disorders and Kidney Problems

Moderator: Welcome to our chat today with Cleveland Clinic nephrologist, Dr. Juan Calle, and Endocrine Calcium Clinic specialist, Dr. Susan Williams. We are thrilled to have them here with us to share their knowledge about Parathyroid/Calcium Disorders and Kidney Problems.


The Clinic & Kidney Disease

subal: Exactly what does an Endocrine Calcium Clinic encompass? Is this a common clinic in many hospitals? Why should I seek one out to deal with my problems?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: Thank you for these excellent questions. The Endocrine Calcium Clinic is a subspecialty within Endocrinology that focuses on bone and mineral metabolism – the most common being calcium. We look at mineral levels, understand how the various vitamins and minerals work together for optimal health, and prescribe supplements, if appropriate, to help treat certain bone-related diseases.

Programs like these are rare; in fact, the Cleveland Clinic Department of Endocrinology is one of very few in the world that has such a clinic. It is staffed by four highly skilled and experienced professionals. If you are having a bone- or mineral-related issue, non-healing fracture(s), persistently low mineral levels, osteoporosis or other bone disease, parathyroid disease or simply low bone density, then you should come to the clinic and see one of us.

Quarter: How serious is chronic kidney disease (CKD) or when does it get serious?

Juan_Calle,_MD: There are different stages of chronic kidney disease. More advanced stages may be serious and potentially life-threatening, as patients may need dialysis (kidney replacement therapy) if severely advanced. This only happens when it reaches stage 5. A patient with stage 3, 4 and 5 CKD should be followed by a nephrologist.

Skylark: I found out my GFR was low (in the mid-50s), and I had a parathyroidectomy at Cleveland Clinic in 2009. A kidney ultrasound was also done then, and it didn't show any abnormality other than the kidney was smaller than normal. There were no signs of disease. I have a small frame (height 5'3"), and I was born about six weeks premature. Since 2009, my GFR has dropped to about 51 and my calcium level has been fine. I've never had HBP or diabetes and my cholesterol is good. I had borderline gestational diabetes, which didn't require treatment.

I'm told there is no treatment until CKD is stage 2. What should I be doing now to preserve kidney function? Is it important to try to determine a reason now for the decreased kidney function? Are there other things besides GFR I should be tracking?

Juan_Calle,_MD: The main recommendation I give to patients in situations like yours is to have very good follow-up with your physician. Following the eGFR is the main thing here and making sure there is no blood or protein in your urine. It is now known that people with low gestational birth weight are at increased risk of lower GFR later in life. However, given your size, it may just be appropriate for you. I would also make sure your blood pressure and blood glucose are well-controlled.


Kidney Stones

kuttyka: I have a 3 mm stone in my right kidney. I also have osteoporosis, hyperparathyroidism and low Vitamin D. I have been having pain under my rib, upper back and under my arm, and have been running a low temperature of 99.7. Would a stone still in the kidney cause this kind of pain?

Juan_Calle,_MD: Yes. It could still cause pain. Also, your low Vitamin D level should be managed appropriately since it may be the cause of the hyperparathyroidism.

mannie: Would you recommend lithotripsy for a kidney stone .6 mm in size shown on a CT scan of the left kidney? In February, I had a 1 cm stone removed from the right side, which was blocking a ureter. I have primary hyperparathyroidism and have had 2½ parathyroid glands removed in two separate surgeries. I am now taking Sensipar® to keep calcium levels down.

Juan_Calle,_MD: It depends on where the stone is located. With that size, there is a very good chance it may pass on its own, but again, it depends on the location. Lithotripsy may help with it, however.

Kidney stone: I have had 18 kidney stones in the last 10 years, and I have been told all the things to avoid eating. Is there anything to ingest to prevent kidney stones?

Juan_Calle,_MD: The main issue is your fluid intake. You should have a metabolic work-up, though, to make sure there is not any other cause for your stones.

ANNE: What are the expected chances of repeat kidney stones for 43- and 67-year-old males with 6 cm to 8 cm calcium oxalate stones every-two years who follow the approved matching calcium-rich, high or moderate oxalate, reduced sodium, increased liquids diet?

Juan_Calle,_MD: In general, people who have a kidney stone and have had no major treatment have a high risk of recurrence. About half of those people will have a recurrence of the stone within four to five years. Unfortunately, the chances are even higher once every recurrence appears. Giving the recurrence of the stone disease, I would suggest a complete metabolic work-up. Most likely, medications will be needed in this situation. I am not aware of any differences in recurrence of the disease based solely on age.

rob: I've had kidney stones in the past (I passed one and had two blasted), but as of August 2013, I was stone-free! I had been on 2000 IU of Vitamin D to get my levels up into the normal range and to lower my PTH levels. For a few years, everything was fine and in August 2013, I was told to drop back to 1000 IU of Vitamin D. All of a sudden, in March 2014, my PTH level spiked back up to 71 from 45 six months prior (although the Vitamin D was pretty stable, from 43 down to only 40). It was recommended to first just repeat the PTH test since it's only borderline high even with the spike. What do you think?

Juan_Calle,_MD: I think that is good advice. I wouldn't jump to big conclusions if there are no major changes in other areas, symptoms or changes in other lab work. The main thing here is good follow-up.

Gail Ann: I have a right upper-pole kidney stone without hydronephrosis. Because the stone could not be localized at the time, I was to have the lithotripsy procedure. However, the procedure could not be performed. My urologist then gave me potassium citrate (1080 mg to be taken three times a day) to alkalinize my urine and dissolve the stone. After one month of taking the potassium citrate, he added sodium bicarbonate, 750 mg to be taken two times a day. After two weeks of taking both medications, my pH still remains 7. He has now eliminated all medications except one dose of the sodium bicarbonate to be taken daily. My questions are the following – To alkalinize urine, what should be the pH level? Has my doctor followed the best course in trying to dissolve the stone? What do you have your patients do to dissolve stones? If the stone will not dissolve, are there any other courses of action to rid myself of this stone?

Juan_Calle,_MD: Alkalinizing the urine to dissolve a stone may only be effective if it is known that the stone is made of uric acid. For other type of stones, "dissolving" the stones may not work and only surgery or other urologic procedures may help to get rid of them. The ideal urine pH if, in fact, they are made of uric acid would be >7.0.

clara: What are the best things to do for repeated kidney stones? Does adding lemon to drinking water actually help?

Juan_Calle,_MD: The main focus to prevent recurrence of stone disease is to drink plenty of fluids (avoiding sweetened drinks and sodas), eat a low-salt diet and limit protein intake (mainly animal protein). Adding lemons/limes does help to prevent kidney stones.

charlie88: Are there any long-term consequences of having a kidney stone?

Juan_Calle,_MD: If it is a single kidney stone, there are usually no major consequences; however, most recently, kidney stone disease has been associated with higher risks for long-term kidney health and cardiovascular diseases. It may also lead to an increased risk of bone disease in the future. The main thing to try to prevent all of these conditions is to have a healthy diet and lifestyle habits, treat diabetes and hypertension if present, and make sure to try to keep a healthy weight.

jenna: My sister has chronic kidney stone issues and she said they are oxalate related. We are trying prevention but the lists contradict each other. Is there a food list of low-oxalate foods or high-oxalate foods? What type of diet should she be following?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: There are many reasons for chronic kidney stones, and although she is having problems with oxalate stones, limiting the oxalates in the diet can be challenging and not always beneficial. The other important fact to know is that oxalates not only come from the diet but also are a byproduct of normal digestion and metabolism of certain vitamins. In fact, it is often the metabolic processes that contribute most to the oxalates in our bodies.

Before I would prescribe a particular diet, it would be important for me to understand more about why she continues to have kidney stones and whether there is an underlying condition that needs to be treated first.


Parathyroid Problems

Sparrow: What does it mean if a parathyroid level goes down to 10 about four years after surgery?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: The parathyroid level can go down quite low if the calcium in the blood is elevated. It may be best to see your physician for this or make an appointment to see me or one of my colleagues in the Endocrine Calcium Clinic.

jessica28: My mother suffers from hyperparathyroidism and seems to have problems with kidney stones. Could parathyroid surgery potentially fix her kidney stone problem?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: Potentially, yes. Hyperparathyroidism can occur with a variety of symptoms, but when kidney stones are involved, oftentimes parathyroid surgery is the appropriate treatment. Please be sure to have her speak with her doctor about this or have her see me or one of my colleagues in the Endocrine Calcium Clinic. We would be glad to investigate this further.

Carie: Can parathyroid issues cause osteoporosis? If yes, will the bone-building drugs work or will the parathyroid have to be removed in order for them to work?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: When one or more of the parathyroid glands is overactive, it can result in bone loss. Although the bone loss may look like osteoporosis on the bone density test, the bone loss from parathyroid disease is very different. When bone loss is due to parathyroid disease, the bone begins to remineralize when the overactive gland is removed. The drugs for osteoporosis are not recommended when parathyroid disease is responsible for the noted bone loss.

R. Heath: Can parathyroid/calcium problems result in hyponatremia?

Juan_Calle,_MD: Not to my knowledge. The only way that I think it could be related is that patients with parathyroid/calcium problems are advised to drink extra water/fluids, and in some patients, that may cause some degree of hyponatremia.

yorkiemom: I am managing my parathyroid levels with hydrochlorothiazide, but in doing research, I have found that this is not a good idea, and I should have my thyroid removed. Will managing my PTH levels with a water pill prevent me from getting kidney disease? Does everyone diagnosed with PTH eventually get kidney disease? I have never had stones, UTIs, etc. I am 60 years old and in excellent health except for this thyroid issue. I am taking Armour®Thyroid, which has been the best thing that happened to me since being off levothyroxine. I lost 25 pounds and am not in a fog since taking Armour. I had a thyroid nuclear scan and two ultrasounds (all done at Cleveland Clinic) and was told I am not a black-and-white case. No tumors were found but now I am not so sure. I think the doctors are missing something. I also have osteoporosis because of my thyroid issues.

Juan_Calle,_MD: I’m not completely sure if you meant thyroid or parathyroid. They are different glands with different functions in the body. Diuretics are not really a treatment for PTH levels, rather for the levels of calcium in the urine that may be caused by the abnormality in the PTH. Not everyone with PTH issues always has kidney disorders. Our endocrine surgeons are excellent and would be happy to see you for a second opinion on the thyroid/parathyroid surgery to see if they agree it is needed.

role33: Is it my imagination or is hyperparathyroid disease becoming increasingly prevalent, and if so, to what do you attribute that?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: I don't think there is a true increased prevalence, but we are getting better at detecting parathyroid disease. Having routine blood tests that include calcium levels are now the norm and often provide us with a clue that perhaps there may be a parathyroid issue.

ANNE: I am a 67-year-old male and I had my parathyroid removed at age 40. I get kidney stones requiring lithotripsy about every two years. I’ve had three total lithotripsies in the recent past. My father died from kidney cancer at age 80. Does the parathyroid removal have anything to do with stone production? Does this increase my risk for kidney cancer?

Juan_Calle,_MD: Parathyroid gland function may be directly related to stone disease. A measurement of its hormone levels and a metabolic work-up, specifically blood work to check on kidney function and electrolytes (minerals) in the blood, along with a routine 24-hour urine collection may be needed. Usually, parathyroid hormone is not regarded as a risk factor for kidney cancer. The main risk factors for kidney cancer are smoking and exposure to other substances, obesity and hypertension.


Calcium & Vitamin D

tommy: What would cause an elevated calcium level?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: Many things can be responsible for an elevated calcium level. Some blood pressure medicines can be responsible for mildly elevated blood calcium levels. Of course, some parathryoid conditions can cause elevated levels. Taking too much calcium or taking a lot of calcium-containing antacids can also elevate the blood calcium. If you note an elevated blood calcium level, be sure to discuss it with you doctor or come to see us at the Endocrine Calcium Clinic.

Ellen: I have hypercalcemia, which was discovered while dealing with kidney stones. Lithotripsy and PCNL have successfully dealt with the calcium oxalate stones. Blood work and a 24-hour urine saturation test all came back within normal range indicators, except for the 388 units of calcium in my urine. My urologist prescribed chlorthalidone to help with the excessive calcium, but I have an allergy to sulfa and developed hives on my face. I currently try to drink at least 64 ounces of fluids daily and limit my intake of oxalates and have not formed any new stones within the last nine months. What other options do I have to treat the hypercalcemia, and what are the long range complications if further treatment is not available?

Juan_Calle,_MD: I’d first make sure your parathyroid and Vitamin D levels are all normal, as treating the hypercalciuria (high calcium in urine) may increase the levels of calcium in the blood even more. There may be other options for treatment, but again, I would make sure other things are in order first.

August30: I am familiar with Vitamin D and calcium absorption basics. Can you explain the relationship between parathyroid hormone and Vitamin D? Is it possible for an individual to have tumors/hyperplasia of the parathyroid(s) without evidence of elevated serum calcium on lab draw (especially with other symptoms such as multiple calcium kidney stones combined with elevated PTH levels)? Also, are tumors/hyperplasia of the parathyroid(s) diagnosed by nuclear scan or another way? If nuclear scan is the correct diagnostic tool, what are the adverse effects of this scan?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: 1) Adequate Vitamin D is essential for both calcium absorption and in maintaining normal parathyroid levels. The parathyroid glands are actually very sensitive to Vitamin D deficiency, and when the body is not able to get enough calcium from the diet, the parathyroid glands “help” get calcium out of the bones in order to keep the blood calcium in the normal range.2) Yes. It is possible to have a parathyroid adenoma (overactive parathyroid) with normal blood calcium levels, but there are usually other signs of a problem, such as repeat kidney stones. 3) Parathyroid adenomas can be detected by ultrasound or by a nuclear scan. Although there is always some level of risk with nuclear scans, the risks of this particular study are minimal, and there are no adverse effects.

Gwalk: Is there a way to control blood calcium other than surgery?

Juan_Calle,_MD: Yes there is, but it all depends on what is causing the calcium abnormality in the blood.

role33: At the end of March, I had surgery for hyperparathryroid disease, and they removed two of the four glands. I take 1500 mg of calcium daily and 4000 mg of Vitamin D daily. Last week, I had a kidney stone that, luckily, I passed. Is this normal to get a kidney stone after surgery for hyperparathyroidism?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: Although unusual, sometimes this does happen. When it happens this soon after surgery, sometimes the question becomes whether that stone was actually there before surgery. Having said that, it is also important to follow-up with the physician treating you for this to see if your Vitamin D and calcium dosages need to be adjusted.

Babrb: What could it mean if my calcium level is normal and my PTH is high?

Juan_Calle,_MD: It depends on the level of the parathyroid hormone. As answered previously by Dr. Williams in another session (August 30), there may still be problems with the parathyroid hormone with normal calcium levels, but other conditions are usually associated with it. Checking the Vitamin D level is also needed, as low Vitamin D levels may increase PTH.

martyl: Is it important to keep track of your calcium intake, calcium levels, etc. if you have hypoparathyroidism? Is there anything else you should track about diet and supplements to be careful?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: Hypoparathryoidism can be particularly challenging, and yes, it is important to see your physician routinely and have the calcium levels checked as recommended. Oftentimes, with true hypoparathyroidism (such as due to surgical removal of all of the glands), getting enough calcium each day can be quite challenging and can sometimes best be accomplished with liquid calcium preparations. However, check with your physician first before making any changes on your own. In addition to calcium, maintaining adequate levels of Vitamin D is also important.

Sam3: What is the primary cause of low Vitamin D? I eat fish and greens and spend time in the sun, yet I have to take a Vitamin D supplement to keep my blood calcium down.

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: This is an excellent question - and one on which scientists and physicians alike continue to disagree. You are correct in that D is the sunshine vitamin, but after about 15 minutes in the sun, the skin loses its ability to make Vitamin D. And although many foods are fortified with Vitamin D, overall, our diets are really quite poor in Vitamin D sources. However, let me clarify something. Taking a Vitamin D supplement will not suppress the blood calcium. Quite the opposite is true. Vitamin D helps to support normal blood calcium levels, and if a patient is having chronically high blood calcium levels, taking a Vitamin D supplement without first being evaluated by a physician is not recommended.

gilucy: My son is 23 years old and has had hypercalcemia since 2010. It was discovered during a routine blood test for an annual exam. His calcium levels have ranged from 10.6 to 11. The sestamibi scan and thyroid ultrasound were negative. He underwent genetic testing for FHH and the CASR mutation was discovered. A bone density scan indicated he is osteopenic in his spine and wrist. He is asymptomatic otherwise. Since it appears he has FHH, which is generally thought to be a benign condition, what would be causing his osteopenia? Where should he go for treatment? An endocrinologist? An orthopaedic doctor? What is the best treatment for someone in his situation?

Juan_Calle,_MD: Patients with FHH and the CASR mutation can have osteopenia, although it is still considered a benign condition. He should probably be seen by an endocrinologist. The treatment would be based on the severity of the disease, but it usually doesn’t require any major interventions.

Bhl930: I have a renal calcium leak. My doctor prescribed Losartan/Hctz 100/25. Do you have any other information regarding this disease? He says I was probably born with it, and about all they can do is try and control the calcium output. My last 24-hour urinalysis was 315, down 150 points.

Juan_Calle,_MD: I agree it is probably a defect you have that is the cause of the “calcium leak,” or hypercalciuria. The treatment is with thiazide-like diuretics (HCTZ), but it is also very important to have a low-sodium (salt) intake.


General Information

rizikhan: My ultrasound report showed some pinpoint in the middle of my kidneys. What does it mean?

Juan_Calle,_MD: I'm sorry, but I may not have a very good answer for this, as it is very nonspecific. Nonetheless, pinpoint may only mean a small calcification, which is usually a non-significant finding unless there are any symptoms associated with it or findings in a simple urinalysis. Another question I would ask is why you had the ultrasound in the first place.

efdjld: I have trace amounts of blood in my urine. My urine was sampled on three consecutive days for a urine cytology, and no infection or cancer cells were found. I also had an ultrasound of my kidneys, bladder, etc., and no abnormalities were seen. I didn't want to have an abdominal CT scan because I've already had three in the past 11 years for other issues and didn't want unnecessary radiation exposure. Additionally, I had a cystoscopy, which was normal. The urologist said that some people normally have trace amounts of blood spill over from their kidneys without there being any disease process present. My questions are: 1) how common is this and 2) does this portend problems in the future?

Juan_Calle,_MD: Blood in the urine is not normal. I would still pursue the CT scan, probably with contrast. However, I would make sure first the hematuria (blood in the urine) is not coming from the kidneys, and you should see a nephrologist for that. Having said that, if kidney function is stable, there is no protein in the urine and no other urological abnormalities seen, then it is probably idiopathic and wouldn’t really be that concerning, but close follow-up should be done.

loveitaly: I have a 32-year-old daughter who has developmental disabilities and several medical conditions (seizure disorder, cerebral palsy, hypothyroidism). She is petite in height due to severe scoliosis. Her weight is low, but correlates with her height. Due to chronic GERD, she is not able to gain weight. With all of these conditions, her health is good; she never gets sick with a virus, cold, etc. We went to a registered dietitian last year. She was very good, and with the best of intentions, she told us to give her a Boost + several times a day, add olive oil to her pureed foods, give her snacks in between meals, etc. Our daughter became sick, wouldn't eat, olive oil didn't agree with her at all. Because of her delayed gastric emptying, she was full at all times. It didn't work at all. We went back to the dietitian and stopped the olive oil, went back to her high-caloric, butter in her meals, more carbs diet, and she has gained around 3 lbs, slowly. Any suggestions, recommendations?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: First, my hat is off to you for being such an attentive caregiver. This can be very challenging indeed. From your question, it sounds as though your daughter’s weight is appropriate for her height, despite her scoliosis. So, I cannot say with certainty that weight gain should be a goal. More importantly, ensuring a balanced diet with palatable foods that she enjoys is recommended. For gastric emptying problems, typically low-fat foods are recommended, and frequent, small meals that include lean protein can often prove beneficial. Liquid supplements that are higher in protein may also be well tolerated.

Quarter: What does an occasional pain (about a minute) in your side signify?

Susan_Williams,_MS,_MD,_CCD,_FACN,_FACP: This is very difficult at best to diagnose over the Internet. My best recommendation would be to see your primary care physician.

Sparrow: I went to Cleveland Clinic for my parathyroid issues, which resulted in an excellent surgery and outcome. However, in my local Toledo area, I was being treated with outdated methods, which only made me worse. Is this prevalent in smaller areas, or is this a lack of knowledge?

Juan_Calle,_MD: As Dr. Williams pointed out before, we are lucky to have very specialized teams that deal with not-so-common medical conditions. Parathyroid diseases may be considered among them. As a big referral center, Cleveland Clinic and its physicians have the opportunity to see and learn more from patients like you. Remember that as in everything else in life, "practice makes perfect," and the more cases we see in a certain area, the most knowledgeable we get about it, too.


Closing

Moderator: I am sorry to say that our time with Dr. Calle and Dr. Williams is now over. Thank you for sharing your expertise and time to answer questions today.

Juan_Calle,_MD: Thank you all so much for your questions. As mentioned before, this is a great opportunity for us to learn from you, and we will be more than happy to help you in a more personalized way in our clinics.


For Appointments

To make an appointment with Dr. Williams, please call 216.444.6568 or visit us online at clevelandclinic.org/endocrinology.

To make an appointment with Dr. Calle, please call 216.444.6771 or visit us online at clevelandclinic.org/kidney.


For More Information

On parathyroidism and calcium disorders
On Cleveland Clinic

Within Cleveland Clinic’s Department of Endocrinology, the Endocrine Calcium Clinic addresses problems associated with the regulation of the body's bone, mineral and hormone functions. Important minerals such as calcium, phosphorus and magnesium are critical for the body’s normal functioning.

Thorough evaluations at the Endocrine Calcium Clinic include DXA bone density scans performed and interpreted by certified specialists. An on-site laboratory is equipped to test markers of bone turnover, mineral and nutrient deficiencies, as well as hormonal abnormalities. An infusion center allows patients to receive injections or infusions of up-to-date therapies.

Cleveland Clinic’s endocrinology services are ranked No. 2 in the nation by U.S. News & World Report. The Endocrine Calcium Clinic consists of a team of experts that specialize in the treatment of a number of common and rare calcium disorders, as well as a unique focus on bone and mineral regulation problems associated with the surgical treatment of obesity. Ancillary facilities allow our experts to perform specialized testing not found in most medical centers, and patients are provided access to therapies using the latest forms of oral and injectable medications for many bone diseases.

Cleveland Clinic's Department of Nephrology and Hypertension has a long history of significant expertise in acute and chronic renal failure. The department offers services in the areas of chronic kidney disease, hypertension, dialysis, kidney transplantation and renal diseases.

Our staff works in a care team model to provide increased availability to physicians and timely consultations for patients. As part of the Glickman Urological and Kidney Institute, the Department of Nephrology and Hypertension is aligned with the departments of Urology and Regional Urology, enabling us to better serve patients in the prevention, diagnosis and treatment of kidney disease.

The Glickman Urological and Kidney Institute at Cleveland Clinic is ranked 2nd in the nation for nephrology by U. S. News & World Report of the nation’s best hospitals 2013-2014.

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Reviewed: 07/14

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