Kidney allograft failure due to acute phosphate nephropathy associated with severe secondary hyperparathyroidism

Abstract

Intratubular calcification is a common finding in renal allografts. However, possible harmful effect of this calcification is not well recognized, and allograft failure purely due to this condition has not been reported. We report a kidney transplant recipient who suffered from severe secondary hyperparathyroidism and unexplained early allograft failure. A diagnosis of acute phosphate nephropathy was made subsequently based on serial allograft biopsy findings. This case calls for a high index of suspicion to look for this rare cause of allograft dysfunction among high-risk patients. It also highlights the importance of good calcium–phosphate control before renal transplantation.

Successful treatment of early allograft dysfunction with cinacalcet in a patient with nephrocalcinosis caused by severe hyperparathyroidism: a case report

“…Association has been established between hyperparathyroidism and delayed graft function [9]. Although some reports appear in the literature [4, 10–13], all of the reports are single-patient case reports (none are large case series) of patients with early graft dysfunction and nephrocalcinosis (Table 1). Among those patients, nephrocalcinosis was detected as early as 5 days after transplantation.…”

“…Nephrocalcinosis is a common finding in renal allografts, with an incidence of 80% at 10 years after transplantation [3]. However, nephrocalcinosis is rarely recognized as the cause of early allograft dysfunction [4]. Here, we present a histological finding of nephrocalcinosis in a renal allograft of a patient with early graft dysfunction.…”