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Published on: March 14, 2017
Renal allograft failure in a hyperparathyroid patient following initiation of a calcimimetic
Claudia Seikrit1, Anja Mühlfeld, Hermann-Josef Groene
1Division of Nephrology and Immunology, RWTH University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. cseikrit@ukaachen.de
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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