Abstract: SA-PO1186
Severe Cortical Nephrocalcinosis After Kidney Transplantation
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Gitter, Christopher B., Duke University Health System Inc, Durham, North Carolina, United States
- Schub, Micah, Duke University Health System Inc, Durham, North Carolina, United States
Introduction
Focal tubular calcium phosphate deposits are common in kidney transplant biopsies, literature reporting up to 30% at 3 months; this is typically focal and medullary. Nephrocalcinosis manifesting as extensive cortical calcification on computed tomography within weeks of transplantation, to our knowledge, has not been described in the literature. This patient represents a unique case of post-transplant Cortical nephrocalcinosis in the absence of rejection.
Case Description
48F with ESRD on peritoneal dialysis and hyperparathyroidism (PTH 869 pg/mL) on cinacalcet underwent deceased donor kidney transplant. Allograft experienced a 39 hour cold ischemic time leading to delayed graft function and resumption of peritoneal dialysis. CT abdomen/pelvis revealed diffuse cortical calcification of renal transplant (Figure 1). Needle core biopsy demonstrated extensive cortical basophilic calcium phosphate crystalline deposits in tubules without evidence of rejection (Figure 2).
She was liberated from dialysis on post op day 11 and re initiated on cinacalcet. Allograft function remained suboptimal, achieving a creatinine nadir of 3.0mg/dL. Repeat imaging 2-month post-transplantredemonstrated cortical hyper density.
Discussion
While histologic evidence of nephrocalcinosis is a common finding post kidney transplant, diffuse cortical nephrocalcinosis leading to porcelain kidney on computed tomography is rare and can lead to allograft dysfunction
Suboptimal phosphorus clearance on peritoneal dialysis, delayed graft function, and ischemia reperfusion injury are potential risk factors for post-transplant nephrocalcinosis.