high akaline phosphatase readings

I am asking this question for a friend of mine who has written
down all the pertinent information, so please excuse me if
I make some errors in transcription.

Callum, who was born 7 1/2 weeks premature, is now 15 1/2 months
old.  His doctors are confused as to why he as an elevated
alkaline phosphatase level - two readings, one at 2600 and the second
at 1600 !

His history is this:    
At 6 months ultrasound showed bilateral hydronephrosis - no symptoms.  
VCUG, renogram & cystoscopy at 7 /12 months.  Bilateral talipes with
subsequent treatment serial casting 9 months, surgical posterior release
of tendons at 7 1/2 months.  Ultrasound at 8 months
showed unilateral hydronephrosis (no symptoms). Blockage never found,
no treatment was given.

Aug 26 at 14 months, he had a unilateral fibrile seizure of 20 minutes
duration with subsequent left arm weakness.  On Sept 15 had a second
seizure, wiht temperature up only 1 degree C.  The arm is now normal,
EEG, CAT were normal.  Sept 24 thru the 30th, there was arching of back,
thrashing, "mournful" crying for 3-4 hours every evening.  Tylenol was
non-efrective, and bloodwork showed Alk Ph level at 2600 on Sept 27,
and 1600 on Oct 1.  Chest and wrist xrays were normal.  Lactose
intolerance is indicated.  Seizures followed several weeks
after doctor advised to try to go back milk products.

What does all this mean and what tests should be performed ?  Your
help is greatly appreciated.

Thank you,
Ed Johnson

[HVM M.D. - EV]

Dear Mr. Johnson-
   I hope I can help you with your questions about Callum.
But I must tell you that I am a general Pediatrician - not a specialist - so my knowledge is not complete.
   First, and easier to deal with - is the recurrence of his  seizures.  I am concerned about the focal findings with weakness in Callum's left arm following his first event at 14 months.  This is not consistent with a simple febrile seizure, where you should not have any focality. Then you mention he has recurrent seizures since the reintroduction of milk.  I have to say that I am not convinced that the two (seizures and milk) are related. But regardless, given the recurrence of seizures - I would encourage the family to seek consultation with a Pediatric Neurologist to review Callum's history and testing.  I am relieved that his Cat scan and EEG were reported as normal.  However, I would recommend seeking a specialist's opinion anyway.
    With regard to the elevated alk phos levels - these abnormal levels may very well indicate some abnormal bone metabolism, as this enzyme usually comes from bones.  I cannot tell you why he is doing this - but these high levels may indicate that he is at risk for growth deficiency and/or boney abnormalities, even deformities.  I think I would seek the consultation of a Pediatric Orthopedist - to evaluate further.  Could this be Rickets ?  Probably not - since the xrays taken are normal.  Could this be an inherited disorder, "Hyperphosphatasemia?"  Again, I would seek the evaluation of a specialist.  Finally - alk phos can also come from the liver - so liver enzymes need to be measured to rule out liver involvement.
   With regard to his hydronephrosis - I would make sure Callum's urine has been checked for any abnormalities and/or signs of infection - and that a Pediatric Urologist or Nephrologist has been called.
    Hopes this helps - Good luck with Callum - Dr. EV