[A case of hypercalcemia in hemodialysis].

Abstract

We report a case of hypercalcemia in a female patient who was restarted on hemodialysis 22 years after renal transplantation. Graft biopsy showed chronic post-transplant nephropathy. Treatment with immunosuppressants and steroids was maintained owing to residual graft function. She was then given oral paracalcitol 1 µg/d for secondary hyperparathyroidism (iPTH 850 pg/mL) and her transplant medication was reduced and then discontinued. After this, the patient referred widespread joint pain, especially in the hips and subsequently presented with erythema nodosum. She also developed hypercalcemia and hyperphosphatemia which persisted after stopping paracalcitol. The clinical picture of increased serum calcitriol, with depressed PTH, suggested sarcoidosis, despite normal ACE levels, a chest X-ray and skin biopsy confirmed the diagnosis, and the patient was started on prednisone 50 mg/day, resulting in prompt normalization of both symptoms and blood chemistry. This is a rare case of hypercalcemia secondary to sarcoidosis in an uremic patient. The sarcoidosis was most likely suppressed by the transplant therapy and rapidly developed after this was suspended. Prompt diagnosis resulted in a good therapeutic response.

• Authors: Cristiana Bagnis, S Berutti, C Vitale, N Ravarino, M Marangella
• Journal: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia (G Ital Nefrol) 2013 Sep-Oct Vol. 30 Issue 5 ISSN: 1724-5990 [Electronic] Italy
• Vernacular Title: Un caso di ipercalcemia in emodialisi.
• PMID: 24941482 (Publication Type: Case Reports, English Abstract, Journal Article)

Topics

• Adult
• Female
• Humans
• Hypercalcemia (diagnosis, drug therapy)
• Renal Dialysis