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Kidney Week

Abstract: PO2162

AKI Caused by Early Post-Kidney-Transplant Nephrocalcinosis Related to Severe Tertiary Hyperparathyroidism

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Nguyen, Nghia, The University of Texas Rio Grande Valley, Edinburg, Texas, United States
  • Varela, Daniel, The University of Texas Rio Grande Valley, Edinburg, Texas, United States
  • Trevino Manllo, Sergio A., The University of Texas Rio Grande Valley, Edinburg, Texas, United States
  • Alsabbagh, Mourad, The University of Texas Rio Grande Valley, Edinburg, Texas, United States
Introduction

Persistent hyperparathyroidism is a common condition in post-kidney transplantation. We present a case of acute kidney injury (AKI) caused by nephrocalcinosis due to tertiary hyperparathyroidism in an early post-renal transplant patient, which was managed and improved with parathyroidectomy.

Case Description

A 42-year-old man with history of diabetes mellitus, hypertension and a deceased donor kidney transplant 3 months prior was evaluated for hypercalcemia. Medications included nifedipine, insulin, mycophenolic acid, tacrolimus and prednisone. Cinacalcet was started but calcium (Ca) level continued to rise. He was later hospitalized for AKI, cinacalcet was discontinued. Blood work showed creatinine (Cr) 2.6 mg/dL (baseline Cr 1.29 mg/dL), corrected Ca 9.9 mg/dL and tacrolimus 6.2 ng/mL. Images of the kidney graft were negative for obstruction. Kidney biopsy revealed no acute rejection or BK infection . However, there were findings of acute tubular injury with frequent calcium phosphate deposits, interstitial fibrosis and tubular atrophy involving 30-40% cortical surface. Interestingly, kidney biopsy obtained 2 months prior was unremarkable. Further workup showed parathyroid hormone 1220 pg/mL, 1,25 di-OH vitamin D 20.1 pg/mL. Given the rapid decline in kidney function and biopsy changes, subtotal parathyroidectomy was performed during the same admission. At 2-week follow-up visit, Cr improved to 1.5 mg/dL.

Discussion

Persistent hyperparathyroidism in post-kidney transplantation can lead to hypercalcemia with nephrocalcinosis, increased mortality and graft loss. These patients usually failed medical therapies. Our case demonstrates that early parathyroidectomy might be the treatment of choice for patients with severe hyperparathyroidism and symptomatic hypercalcemia.

Kidney biopsy in Nephrocalcinosis - Acute tubular injury with calcium phosphate deposits, interstitial fibrosis and tubular atrophy