From the Guidelines
Low alkaline phosphatase (ALP) levels can be a hint to suggest Wilson disease in the absence of other indicators, particularly when accompanied by a high bilirubin to alkaline phosphatase ratio, as indicated in the AASLD position paper on the management of acute liver failure 1. When evaluating low ALP levels, it is crucial to consider the underlying causes, which may include Wilson disease, a rare genetic disorder that can lead to acute liver failure.
- Key characteristics of Wilson disease include low serum ceruloplasmin, high serum and urinary copper levels, and hepatic copper measurement, which can confirm the diagnosis.
- A high bilirubin to alkaline phosphatase ratio (greater than 2.0) is a reliable indicator of Wilson disease in the setting of acute liver failure, as noted in the AASLD position paper 1.
- Treatment for Wilson disease in the context of acute liver failure involves measures to acutely lower serum copper and limit further hemolysis, such as albumin dialysis, continuous hemofiltration, plasmapheresis, or plasma exchange, rather than initiation of treatment with penicillamine, which is not recommended due to the risk of hypersensitivity 1.
- It is essential to consult with a healthcare provider for proper evaluation and diagnosis, as low ALP levels themselves are not typically dangerous, but the underlying condition causing them might require treatment.
- Further testing, including liver function tests, thyroid function, zinc levels, and possibly genetic testing, may be necessary to determine the cause of low ALP levels and guide appropriate treatment.
From the Research
Low Alk Phos
- Low alkaline phosphatase (ALP) levels can be associated with various conditions, including hypophosphatasia, a rare genetic disorder characterized by defective bone mineralization 2.
- In patients with chronic kidney disease (CKD), low ALP levels may be related to adynamic bone disease, a condition where bone turnover is decreased 3.
- However, it is essential to note that low ALP levels can also be seen in other conditions, such as vitamin D deficiency or zinc deficiency, which can be treated with supplementation 2.
- The clinical significance of low ALP levels depends on the underlying condition and should be interpreted in the context of other laboratory results and clinical findings.
- Some studies suggest that ALP can be a useful biomarker in CKD-mineral bone disorder, as it reflects bone turnover and predicts outcomes in hemodialysis patients 3, 4.
- Recent research has also highlighted the potential role of ALP in the pathogenesis of cardiovascular disease and mortality in CKD patients, making it a promising target for treatment 5, 4.
Related Conditions
- Hypophosphatasia: a rare genetic disorder characterized by defective bone mineralization, which can be associated with low ALP levels 2.
- Chronic kidney disease (CKD): a condition where low ALP levels may be related to adynamic bone disease or other mineral and bone disorders 6, 3, 5, 4.
- Vitamin D deficiency: a condition that can be treated with supplementation and may be associated with low ALP levels 2.
- Zinc deficiency: a condition that can be treated with supplementation and may be associated with low ALP levels 2.
Laboratory Results
- ALP levels: can be measured in serum or plasma and are essential for diagnosing and monitoring various conditions, including hypophosphatasia and CKD-mineral bone disorder 2, 3, 4.
- Parathyroid hormone (PTH) levels: can be used in conjunction with ALP levels to assess bone turnover and mineral metabolism in CKD patients 3, 4.
- Vitamin D levels: can be measured to diagnose and monitor vitamin D deficiency, which may be associated with low ALP levels 2.
- Zinc levels: can be measured to diagnose and monitor zinc deficiency, which may be associated with low ALP levels 2.