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Glomerular calcification in hypercalcemic nephropathy.

Jeffrey R Henegar1, John P Coleman, Julio Cespedes

  • 1Department of Pathology and Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA. jhenegar@pathology.umsmed.edu

Archives of Pathology & Laboratory Medicine
|February 4, 2003
PubMed
Summary
This summary is machine-generated.

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Glomerular calcification, previously considered rare in hypercalcemic nephropathy, was found to be significant in two patients with extreme hypercalcemia. This finding suggests glomerular calcinosis contributes to kidney damage and segmental glomerulosclerosis.

Area of Science:

  • Nephrology
  • Pathology
  • Endocrinology

Background:

  • Hypercalcemic nephropathy is typically classified as a tubulointerstitial renal disease.
  • Glomerular pathological findings due to hypercalcemia are infrequently reported, considered unusual.
  • This study investigates calcium deposition within glomeruli in severe hypercalcemia cases.

Observation:

  • Two patients with extreme hypercalcemia (20.2 mg/dL and 18.4 mg/dL) and hypercalcemic nephropathy were studied.
  • Patient 1 (T-cell lymphoma/leukemia) showed glomerular capillary basement membrane calcium deposits with segmental sclerosis.
  • Patient 2 (primary hyperparathyroidism) exhibited extensive glomerular calcification, including mesangial areas and Bowman's space.

Findings:

  • Glomerular calcification was prominent, exceeding tubular calcification in cortical and outer medullary regions in one patient.

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  • Segmental sclerosing lesions were associated with glomerular calcium deposits in both patients.
  • No evidence of primary glomerular disease was found via immunofluorescence or electron microscopy.

    • Implications:

    • Glomerular calcification may be a significant contributor to renal function loss in hypercalcemic nephropathy.
    • Glomerular calcinosis should be recognized as a cause of segmental glomerulosclerosis and nephrotic syndrome in severe hypercalcemia.
    • These findings may alter the understanding and classification of renal pathology in hypercalcemic states.