Abstract: SA-PO0624
Delayed Hypercalcemia and AKI After Polymethylmethacrylate Buttock Augmentation
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 2
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Palani, Maanasa, Medical City Fort Worth, Fort Worth, Texas, United States
- Harish, Rachana, Medical City Fort Worth, Fort Worth, Texas, United States
- Balamuthusamy, Saravanan, Medical City Fort Worth, Fort Worth, Texas, United States
- Madhrira, Machaiah M., Medical City Fort Worth, Fort Worth, Texas, United States
Introduction
PMMA injections for cosmetic augmentation can trigger foreign body granulomatous reactions, causing unregulated extra-renal calcitriol synthesis by activated macrophages overexpressing CYP27B1, independent of PTH feedback. This sarcoidosis like mechanism may present years after injection and carries significant renal morbidity
Case Description
A 51-year-old woman with CKD and hypertension developed AKI (creatinine 3.9 mg/dL from baseline 2.0 mg/dL) following IV zoledronate for resistant hypercalcemia (total calcium 13 mg/dL, ionized calcium 6 mg/dL). Evaluation revealed 1,25-dihydroxyvitamin D markedly elevated at 188 pg/mL, suppressed PTH, and normal 25-hydroxyvitamin D. Workup for malignancy, sarcoidosis, and autoimmune conditions was unrevealing. Kidney biopsy showed 30–40% tubular atrophy and interstitial fibrosis. IV fluids and hydrochlorothiazide discontinuation provided transient improvement, but hypercalcemia recurred. Further history disclosed PMMA gluteal augmentation and saline breast implants placed 10 years prior; MRI confirmed left implant rupture. PMMA was identified to be the cause and prednisone 20 mg daily was initiated, with calcium normalization over 5 weeks
Discussion
Granulomatous hypercalcemia should be considered in PTH-independent hypercalcemia with elevated calcitriol once standard etiologies are excluded. AKI occurs in over 80% of reported cases, making early recognition critical. Clinicians must inquire about cosmetic filler procedures like PMMA, as patients frequently omit this history. Silicone implant rupture, unlike saline implants can independently trigger granulomatous disease via the same CYP27B1-dependent mechanism. Long-term nephrology follow-up and glucocorticoid titration are essential for renal preservation
Above:CT abdomen showing buttock post PMMA
Below:Light microscopy of kidney showing 40% Fibrosis