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Renal allograft failure in a hyperparathyroid patient following initiation of a calcimimetic

Nature Reviews Nephrology volume 7, pages 237–241 (2011)Cite this article

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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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Figure 1: Laboratory test results demonstrating the clinical course of the patient following renal transplantation.
Figure 2: Histology of the renal allograft on day 24 post-transplantation and after graft recovery on day 51.

References

  1. 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).

    Article  CAS  Google Scholar 

  2. 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).

    Article  Google Scholar 

  3. Roodnat, J. I. et al. High pretransplant parathyroid hormone levels increase the risk for graft failure after renal transplantation. Transplantation 82, 362–367 (2006).

    Article  CAS  Google Scholar 

  4. Evenepoel, P. et al. Calcium metabolism in the early posttransplantation period. Clin. J. Am. Soc. Nephrol. 4, 665–672 (2009).

    Article  CAS  Google Scholar 

  5. Gwinner, W. et al. Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am. J. Transplant. 5, 1934–1941 (2005).

    Article  Google Scholar 

  6. 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).

  7. Srinivas, T. R. et al. Improvement in hypercalcemia with cinacalcet after kidney transplantation. Clin. J. Am. Soc. Nephrol. 1, 323–326 (2006).

    Article  CAS  Google Scholar 

  8. 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).

    Article  CAS  Google Scholar 

  9. El-Amm, J. M. et al. Preliminary experience with cinacalcet use in persistent secondary hyperparathyroidism after kidney transplantation. Transplantation 83, 546–549 (2007).

    Article  CAS  Google Scholar 

  10. 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).

    Article  CAS  Google Scholar 

  11. Leca, N. et al. Early and severe hyperparathyroidism associated with hypercalcemia after renal transplant treated with cinacalcet. Am. J. Transplant. 6, 2391–2395 (2006).

    Article  CAS  Google Scholar 

  12. Szwarc, I. et al. Cinacalcet chloride is efficient and safe in renal transplant recipients with posttransplant hyperparathyroidism. Transplantation 82, 675–680 (2006).

    Article  CAS  Google Scholar 

  13. Serra, A. L. et al. Effective control of persistent hyperparathyroidism with cinacalcet in renal allograft recipients. Nephrol. Dial. Transplant. 22, 577–583 (2007).

    Article  CAS  Google Scholar 

  14. Clinical Trials. Using cinacalcet to treat the hypophosphatemia of early kidney transplant [online], (2009).

  15. Clinical Trials. Post transplant study [online], (2007).

  16. 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).

    Article  Google Scholar 

  17. Esposito, L. et al. Hypercalciuria induced by a high dose of cinacalcet in a renal-transplant recipient. Clin. Nephrol. 68, 245–248 (2007).

    Article  CAS  Google Scholar 

  18. Borchhardt, K. A. et al. Cinacalcet increases calcium excretion in hypercalcemic hyperparathyroidism after kidney transplantation. Transplantation 86, 919–924 (2008).

    Article  CAS  Google Scholar 

  19. Serra, A. L. et al. Pharmacokinetics and pharmacodynamics of cinacalcet in patients with hyperparathyroidism after renal transplantation. Am. J. Transplant. 8, 803–810 (2008).

    Article  CAS  Google Scholar 

  20. 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).

    Article  CAS  Google Scholar 

  21. Torres, A., Lorenzo, V. & Salido, E. Calcium metabolism and skeletal problems after transplantation. J. Am. Soc. Nephrol. 13, 551–558 (2002).

    PubMed  Google Scholar 

  22. Boom, H. et al. Calcium levels as a risk factor for delayed graft function. Transplantation 77, 868–873 (2004).

    Article  CAS  Google Scholar 

  23. Rayes, N. et al. Long-term results of subtotal vs total parathyroidectomy without autotransplantation in kidney transplant recipients. Arch. Surg. 143, 756–761 (2008).

    Article  Google Scholar 

  24. 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).

    Article  Google Scholar 

  25. Hebert, S. C. Bartter syndrome. Curr. Opin. Nephrol. Hypertens. 12, 527–532 (2003).

    Article  Google Scholar 

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Acknowledgements

Written consent for publication was obtained from the patient.

Author information

Authors and Affiliations

  1. Division of Nephrology and Immunology, RWTH University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Claudia Seikrit, Anja Mühlfeld & Jürgen Floege

  2. Department of Cellular and Molecular Pathology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany

    Hermann-Josef Groene

Authors
  1. Claudia Seikrit
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  2. Anja Mühlfeld
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  4. Jürgen Floege
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Contributions

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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Correspondence to Claudia Seikrit.

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Competing interests

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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