Bisphosphonate therapy for persistent hyperparathyroidism after kidney transplantation-A case report

Area of Science:

• Nephrology
• Endocrinology
• Transplantation

Background:

• Post-transplant hyperparathyroidism (PT-HPT) is a frequent complication in kidney transplant recipients (KTRs).
• PT-HPT can lead to nephrocalcinosis and compromise graft function.
• Current treatments like cinacalcet may increase calciuria, potentially worsening nephrocalcinosis.

Observation:

• A kidney transplant recipient with end-stage renal disease experienced persistent PT-HPT and progressive renal impairment post-transplant.
• Graft biopsy revealed widespread tubular calcifications, indicating nephrocalcinosis.
• The patient was treated with cinacalcet and intravenous pamidronate.

Findings:

• Concurrent administration of pamidronate with cinacalcet led to a decrease in alkaline phosphatase levels.
• Despite refractory PT-HPT, renal function showed improvement.
• Following parathyroidectomy, renal function remained stable for up to four years.

Implications:

• This case suggests that pamidronate, in conjunction with cinacalcet, may be a viable therapeutic option for managing PT-HPT-associated nephrocalcinosis.
• This combination therapy could potentially preserve kidney graft function in KTRs.
• Further research is warranted to confirm the efficacy and safety of this combined approach.