Hypercalcemia after renal transplantation

Schwartz, Gabriel H.; David, David S.; Riggio, Robert R.; Saville, Paul D.; Whitsell, John C.; Stenzel, Kurt H.; Rubin, Albert L.

doi:10.1016/s0002-9343(70)80112-7

Cited by 70 publications

(16 citation statements)

References 44 publications

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“…Vezzoli et al (20) reported iCa levels exceeding 1.29 mmol/L in 27 of 41 renal transplant recipients, which represent a prevalence rate that is close to ours. Most studies assessing post-transplant calcium metabolism thus far analyzed uncorrected or albumin-corrected tCa levels and reported substantially lower prevalences of hypercalcemia (7)(8)(9)(10)(11)21,22). Also in this study, hypercalcemia, defined as tCa Ͼ10.3 mg/dl, was observed in only 13.1% of the patients.…”

Section: Discussionmentioning

confidence: 49%

“…It should be of note that, in this study, only 49% of the patients with metabolic acidosis at month 3 were given bicarbonate supplementation. Most studies investigating the natural history of calcium metabolism after successful renal transplantation published thus far are hampered by cross-sectional design, small sample size, or short follow-up (11,21,22,32,33). In this study, which is free of these limitations, we showed a significant decline in the prevalence of "true" hypercalcemia between month 3 and month 12.…”

Section: Discussionmentioning

confidence: 60%

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Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Evenepoel¹,

Bammens²,

Claes³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hypercalcemia is a common complication in renal transplant recipients and has been associated with nephrocalcinosis and poor graft outcome. The performance of total calcium (tCa) in the diagnosis of blood calcium disturbances in renal transplant recipients is unknown.Design, setting, participants, & measurements: We compared the ability of total tCa concentration to identify low, normal, or high ionized calcium (iCa) concentration, i.e., the gold standard, in an unselected cohort of 268 renal transplant recipients. All patients were studied 3 and 12 months after successful engraftment.Results: Hypercalcemia, defined as a iCa >1.29 mmol/L, was present in 58.6 and 44.8% of the patients at months 3 and 12, respectively. tCa concentrations >10.3 mg/dl, conversely, were observed in only 13.1% of the patients. Measuring tCa had a low sensitivity ( Conclusions: Total calcium greatly underestimates the diagnosis of hypercalcemia in incident renal transplant recipients. This is mainly explained by the high prevalence of metabolic acidosis in these patients.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 60%

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Evenepoel¹,

Bammens²,

Claes³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…O ver the years, several investigators have been studying calcium (Ca) metabolism in renal transplant recipients (1)(2)(3)(4)(5)(6)(7). Hypercalcemia is reported in up to 66% of the transplant recipients and typically occurs within the first 3 mo after transplantation.…”

mentioning

confidence: 99%

Calcium Metabolism in the Early Posttransplantation Period

Evenepoel

Bergh²,

Naesens³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period.Design, setting, participants, & measurements: In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3.Results: Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling.Conclusions: Our data indicate that both hypo-and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.

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“…Decreased phosphorus absorption (resulting from glucocorticoid therapy) and a high i-PTH level could be factors contributing to hypophosphatemia after renal transplantation. [8] Tertiary hyperparathyroidism is also a common finding after renal transplantation. In our patient, although the high i-PTH levels persisted before infection, he did not develop post-transplant hypercalcemia or hypophosphatemia.…”

Section: Discussionmentioning

confidence: 99%

Hypercalcemia and Suppressed PTH Levels in a Renal Transplant Patient Infected withPneumocystis Carinii

et al. 2007

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Pneumocystis carinii pneumonia is a serious and relatively common complication of immunosuppressive therapy. In immunocompromised patients, P. carinii pneumonia can cause significant morbidity and mortality. Another common complication, typically seen in the subpopulation of renal transplant recipients, is hypercalcemia. The prevalence of hypercalcemia varies, reaching as high as 71%. We report the case of a renal transplant recipient who developed P. carinii pneumonia and hypercalcemia, the latter being resolved after the successful treatment of the former. We argue that there is a causal relationship between P. carinii pneumonia and hypercalcemia in renal transplant recipients. In immunocompromised patients, pulmonary infection accompanied by hypercalcemia should raise the suspicion of P. carinii pneumonia.

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Hypercalcemia after renal transplantation

Cited by 70 publications

References 44 publications

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Calcium Metabolism in the Early Posttransplantation Period

Hypercalcemia and Suppressed PTH Levels in a Renal Transplant Patient Infected withPneumocystis Carinii

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