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Hypercalcemia and human nature.

N Ashman1, H H Malluche, J Cunningham

  • 1Department of Renal Medicine and Transplantation, Royal London and St. Bartholomew's Hospitals, Whitechapel, UK. N.Ashman@mds.qmw.ac.uk

Clinical Nephrology
|May 4, 2001
PubMed
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Patients on hemodialysis can experience severe hypercalcemia. This case highlights unusual causes like extrarenal vitamin D synthesis and aluminum intoxication, emphasizing diagnostic challenges in complex kidney disease patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Biochemistry

Background:

  • Patients undergoing hemodialysis are susceptible to hypercalcemia, particularly when skeletal buffering capacity is compromised.
  • Understanding the diverse etiologies of hypercalcemia in end-stage renal disease is crucial for effective patient management.

Observation:

  • A case of persistent hypercalcemia in a hemodialysis patient with suspected extrarenal vitamin D synthesis.
  • Clinical presentation suggested aluminum intoxication, confirmed by desferrioxamine challenge, and adynamic uremic osteodystrophy on bone biopsy.

Findings:

  • Plasma calcitriol levels were unresponsive to corticosteroids but suppressed with ketoconazole, ruling out typical granulomatous causes.
  • The findings point towards non-classical mechanisms of hypercalcemia in the context of renal disease and potential toxin exposure.

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Implications:

  • This case underscores the importance of considering less common causes of hypercalcemia in hemodialysis patients.
  • Highlights diagnostic challenges and the need for a comprehensive approach, including evaluating for toxin-induced conditions and factitious disorders.