Abstract
Background. A 47-year-old man with a 6-year history of chronic dialysis for end-stage renal disease of unknown etiology presented for renal transplantation. While on dialysis, he had developed secondary hyperparathyroidism, which persisted after transplantation despite treatment with cinacalcet.
Investigations. Physical examination, serum and urine analysis, ultrasound of the renal transplant, renal biopsy, bone scintigraphy.
Diagnosis. Severe persistent hyperparathyroidism associated with mild hypercalcemia following renal transplantation. Initiation of a calcimimetic followed by fulminant graft failure. Extensive tubular calcinosis.
Management. Renal transplantation (with immunosuppressant medications: basiliximab, tacrolimus, mycophenolate mofetil, prednisolone), cinacalcet (halted on day 26 after transplantation), angiotensinconverting-enzyme inhibitor, angiotensin-receptor blocker, hydrochlorothiazide, emergency dialysis, subtotal parathyroidectomy.
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References
Evenepoel, P. et al. Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study. Nephrol. Dial. Transplant. 19, 1281–1287 (2004).
Egbuna, O. I., Taylor, J. G., Bushinsky, D. A. & Zand, M. S. Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure. Clin. Transplant. 21, 558–566 (2007).
Roodnat, J. I. et al. High pretransplant parathyroid hormone levels increase the risk for graft failure after renal transplantation. Transplantation 82, 362–367 (2006).
Evenepoel, P. et al. Calcium metabolism in the early posttransplantation period. Clin. J. Am. Soc. Nephrol. 4, 665–672 (2009).
Gwinner, W. et al. Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am. J. Transplant. 5, 1934–1941 (2005).
KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD–MBD). Kidney Int. Suppl. S1–S130 (2009).
Srinivas, T. R. et al. Improvement in hypercalcemia with cinacalcet after kidney transplantation. Clin. J. Am. Soc. Nephrol. 1, 323–326 (2006).
Kruse, A. E., Eisenberger, U., Frey, F. J. & Mohaupt, M. G. The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism. Nephrol. Dial. Transplant. 20, 1311–1314 (2005).
El-Amm, J. M. et al. Preliminary experience with cinacalcet use in persistent secondary hyperparathyroidism after kidney transplantation. Transplantation 83, 546–549 (2007).
Serra, A. L., Schwarz, A. A., Wick, F. H., Marti, H. P. & Wuthrich, R. P. Successful treatment of hypercalcemia with cinacalcet in renal transplant recipients with persistent hyperparathyroidism. Nephrol. Dial. Transplant. 20, 1315–1319 (2005).
Leca, N. et al. Early and severe hyperparathyroidism associated with hypercalcemia after renal transplant treated with cinacalcet. Am. J. Transplant. 6, 2391–2395 (2006).
Szwarc, I. et al. Cinacalcet chloride is efficient and safe in renal transplant recipients with posttransplant hyperparathyroidism. Transplantation 82, 675–680 (2006).
Serra, A. L. et al. Effective control of persistent hyperparathyroidism with cinacalcet in renal allograft recipients. Nephrol. Dial. Transplant. 22, 577–583 (2007).
Clinical Trials. Using cinacalcet to treat the hypophosphatemia of early kidney transplant [online], (2009).
Clinical Trials. Post transplant study [online], (2007).
Peng, L. W., Logan, J. L., James, S. H., Scott, K. M. & Lien, Y. H. Cinacalcet-associated graft dysfunction and nephrocalcinosis in a kidney transplant recipient. Am. J. Med. 120, e7–e9 (2007).
Esposito, L. et al. Hypercalciuria induced by a high dose of cinacalcet in a renal-transplant recipient. Clin. Nephrol. 68, 245–248 (2007).
Borchhardt, K. A. et al. Cinacalcet increases calcium excretion in hypercalcemic hyperparathyroidism after kidney transplantation. Transplantation 86, 919–924 (2008).
Serra, A. L. et al. Pharmacokinetics and pharmacodynamics of cinacalcet in patients with hyperparathyroidism after renal transplantation. Am. J. Transplant. 8, 803–810 (2008).
Serra, A. L., Wuhrmann, C. & Wuthrich, R. P. Phosphatemic effect of cinacalcet in kidney transplant recipients with persistent hyperparathyroidism. Am. J. Kidney Dis. 52, 1151–1157 (2008).
Torres, A., Lorenzo, V. & Salido, E. Calcium metabolism and skeletal problems after transplantation. J. Am. Soc. Nephrol. 13, 551–558 (2002).
Boom, H. et al. Calcium levels as a risk factor for delayed graft function. Transplantation 77, 868–873 (2004).
Rayes, N. et al. Long-term results of subtotal vs total parathyroidectomy without autotransplantation in kidney transplant recipients. Arch. Surg. 143, 756–761 (2008).
Evenepoel, P., Claes, K., Kuypers, D. R., Debruyne, F. & Vanrenterghem, Y. Parathyroidectomy after successful kidney transplantation: a single centre study. Nephrol. Dial. Transplant. 22, 1730–1737 (2007).
Hebert, S. C. Bartter syndrome. Curr. Opin. Nephrol. Hypertens. 12, 527–532 (2003).
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All authors contributed to researching data for this article, and reviewed/edited the manuscript before submission and revised it after peer review. J. Floege also wrote the article.
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J. Floege declares that he has received honoraria and research support from Amgen. The other authors declare no competing interests.
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Seikrit, C., Mühlfeld, A., Groene, HJ. et al. Renal allograft failure in a hyperparathyroid patient following initiation of a calcimimetic. Nat Rev Nephrol 7, 237–241 (2011). https://doi.org/10.1038/nrneph.2010.169
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DOI: https://doi.org/10.1038/nrneph.2010.169
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