Abstract: FR-PO0475
Beyond Vitamin D: Severe Hypercalcemia and AKI as an Unusual Presentation of Sarcoidosis
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Berbari, Iskandar, Emory University School of Medicine, Atlanta, Georgia, United States
- Waheed, Sana, Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Hypercalcemia is a known complication of granulomatous diseases. Its physiologically attributed to increased conversion of 25-hydroxy vitamin D to 1, 25-dihydroxy vitamin D within the granulomas. We present a case of severe hypercalcemia in sarcoidosis despite normal 1, 25-dihydroxy vitamin D level.
Case Description
56-year-old male from Nigeria with past medical history of CKD stage IIIb with a baseline creatinine of 2.1 mg/dL presented with an AKI and a creatinine of 7.5 mg/dL, calcium of 15.2 mg/dL, phosphorus of 6.8 mg/dL, diffuse lymphadenopathy and mild splenomegaly. Kidneys were normal in size with no kidney stones and no obstruction. Urinalysis showed 2-5 white cells, 26-50 RBCs, 1+ protein with a urine protein to creatinine ratio of 892 mg/g and urine albumin to creatinine ratio of 64 mg/g. Further workup revealed a normal serum protein electrophoresis, urine protein electrophoresis and a mildly elevated kappa to lambda ratio of 1.93. PTH related protein was 13 pmol/L, 25-hydroxy vitamin D was low at 19 mg/dL, 1, 25-dihydroxy vitamin D was normal at 60 pg/mL and PTH was suppressed at 4.2 pg/mL. Patient received calcitonin and denosumab with resolution of hypercalcemia and improvement of AKI with creatinine trending down to 2.1 mg/dL. He subsequently underwent lymph node biopsy, which showed noncaseating granulomas consistent with sarcoidosis as AFB and Fingal stains were negative.
Discussion
This case highlights that sarcoidosis can cause hypercalcemia even with inappropriately normal 1,25-dihydroxy vitamin D levels despite low 25-hydroxy vitamin D levels. Although most cases of hypercalcemia in sarcoidosis have been attributed to elevated 1, 25-dihydroxy vitamin D levels, alternate mechanisms such as cytokine-mediated increased bone turnover may contribute.