ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO233

Pneumocystis jirovecii Pneumonia-Induced Hypercalcemia

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Thomas, Dominik, University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction

A growing number of case reports demonstrate the relationship between non-parathyroid mediated hypercalcemia preceding or occurring in conjunction with a diagnosis of Pneumocystis jirovecii pneumonia (PJP). Most cases described in literature occur in kidney transplant patients. We present a patient with heart transplant with nonspecific symptoms, acute kidney injury and hypercalcemia.

Case Description

63 year old female with history of breast cancer status post chemoradiation with anthracycline induced cardiomyopathy requiring orthotopic heart transplant two years earlier presented with fever, chills, weight loss and fatigue for two months. She reported in addition a dry cough with increasing shortness of breath. She presented with a serum creatinine (SCr) of 5.23mg/dl, up from a baseline of 2.2 mg/dl. Creatinine improved to 4.1mg/dl after intravenous hydration. Admission urinalysis unremarkable. Renal US was with increased bilateral echogenicity. Serum Calcium was 12.9 mg/dl on admission with PTH of 7 pmg/ML (15-65 pmg/mL) and 1,25 Vitamin D of 87pg/mL. (19.9-79.3 pg/mL). CT chest demonstrated patchy ground glass opacities throughout the lungs. Infectious work up revealed Beta-D-Glucan >500. A bronchoscopy with BAL was performed and returned positive for PJP on PCR. She was started on atovaquone with improvement in symptoms. Cr trended down to baseline with resolution of hypercalcemia.

Discussion

Hypercalcemia related to PJP is thought to be associated via 1α-hydroxylase enzyme-dependent mechanism causing extra-renal production of 1α-hydroxylase. Some reports of PJP revealed the presence of inflammatory granulomas rich in macrophages and monocytes that are capable of vitamin D activation and thereby inducing hypercalcemia. The majority of cases are described in kidney transplant recipients possibly suggesting a susceptibility in these patients for developing PJP-related hypercalcemia but PJP can occur with any solid organ transplant.