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Hypercalcemia post renal transplant

Larissa Kruger Gomes, Melani Ribeiro Custódio, Fabiana Loss de Carvalho Contieri, Miguel C Riella, Marcelo Mazza do Nascimento
Introduction: The persistence of mineral metabolism disorders after renal transplant (RT) appears to possess a negative impact over graft and patient's survival. Objectives: To evaluate the parameters of mineral metabolism and the persistence of hyperparathyroidism (HPT) in transplanted patients for a 12-month period after the procedure. Methods: Retrospective analysis of 41 transplants (18 women- 44%, mean age of 39 ± 15 years) performed in a University Hospital, evaluating changes of calcium (Ca), phosphorus (P) and parathyroid hormone (PTH) and the prevalence of persistent HPT...
July 2016: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Pahnwat T Taweesedt, Sinee Disthabanchong
After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels...
December 24, 2015: World Journal of Transplantation
Ramón Alberto Tamayo-Isla, Mauro Cuba de la Cruz
INTRODUCTION: Calciphylaxis is a rare medical condition that is usually diagnosed in patients suffering from end-stage renal disease who are already receiving renal replacement therapy and in those post-transplantation. The pathogenesis still remains to be fully elucidated; hence, the treatment is not uniform. The prognosis is generally poor. The ulcerative stage exhibits a worse prognosis than the nonulcerative one. Calciphylaxis presenting in terminal kidney disease prior to dialytic treatment has only rarely been reported...
2015: International Journal of Nephrology and Renovascular Disease
Lindel C Dewberry, Sudha Tata, Sharon Graves, Collin J Weber, Jyotirmay Sharma
BACKGROUND: Tertiary hyperparathyroidism (3°HPT) is hyperparathyroidism with hypercalcemia after renal transplantation. With unclear guidelines for parathyroidectomy (PTX), this study aims to determine which renal transplant patients develop 3°HPT and would benefit from PTX. METHODS: We performed a retrospective review of patients who received a renal transplant between 1994 and 2013; 105 patients who underwent near total PTX (NTPTX) were compared with 180 renal transplant control patients who did not undergo NTPTX...
December 2014: Surgery
Lindel Krige Dewberry, Collin Weber, Jyotirmay Sharma
Tertiary hyperparathyroidism (3°HPT) is defined as persistent hyperparathyroidism with hypercalcemia after renal transplantation. Near total parathyroidectomy (NTPTX) is the current standard for surgical intervention. The purpose of this study was to identify outcomes of NTPTX. A retrospective review was conducted of surgeries performed between 1994 and 2013. NTPTX resulted in resolution of 96.9 per cent of patients' hypercalcemia at a median follow-up of three years (interquartile range [IQR], 1 to 8). However, 3...
July 2014: American Surgeon
Cristiana Bagnis, S Berutti, C Vitale, N Ravarino, M Marangella
We report a case of hypercalcemia in a female patient who was restarted on hemodialysis 22 years after renal transplantation. Graft biopsy showed chronic post-transplant nephropathy. Treatment with immunosuppressants and steroids was maintained owing to residual graft function. She was then given oral paracalcitol 1 µg/d for secondary hyperparathyroidism (iPTH 850 pg/mL) and her transplant medication was reduced and then discontinued. After this, the patient referred widespread joint pain, especially in the hips and subsequently presented with erythema nodosum...
September 2013: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
N Muirhead, J S Zaltman, J S Gill, D N Churchill, M Poulin-Costello, V Mann, E H Cole
Hypercalcemia, occurring in up to 25% of patients within 12 months following renal transplantation, and persistent hyperparathyroidism were evaluated following renal transplantation, by retrospective chart review of 1000 adult patients transplanted between January 1, 2003 and January 31, 2008 with at least six months follow-up. Serum calcium, parathyroid hormone, and phosphate levels were recorded at 12, 24, 36, and 48 months. Average follow-up was 766 (535) d (mean (SD); median 668 d). Majority were first transplants (85%); deceased donor 57%...
February 2014: Clinical Transplantation
José-Vicente Torregrosa, Xoana Barros
Post-transplant hypercalcemia due to persistent secondary hyperparathyroidism (HPT) has a high prevalence in the first 3 months after surgery and decreases during the first year, but it persists over time in around 5-10% of renal transplant patients. The increased bone resorption and tubular reabsorption of calcium due to the action of the parathyroid hormone (PTH) appear to be the main mechanisms involved in hypercalcemia. At the time of the renal transplantation (RT), PTH is the factor that determines the development of post-RT hypercalcemia, although it is sometimes masked in patients who are well controlled with medical treatment...
November 13, 2013: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Walter Guillermo Douthat, Carlos Raul Chiurchiu, Pablo Ulises Massari
The persistence and severity of hyperparathyroidism (HPT) post-renal transplantation is relatively frequent and primarily associated with the timing and its magnitude in the pre-transplant period and with the presence of parathyroid adenomas. HPT after renal transplantation is clinically manifested with hypercalcemia, hypophosphatemia, bone pain, fractures, and in more serious cases with cardiovascular calcifications that affect the survival. The primary clinical objective for patients with secondary HPT after renal transplantation is to obtain a level of parathyroid hormone (PTH) adequate to the renal transplanted function and to normalize levels of calcium, phosphorus and vitamin D...
June 24, 2012: World Journal of Transplantation
Michio Nakamura, Kiho Tanaka, Yuhji Marui, Shinji Tomikawa
Deceased donor kidney transplantation in long-term dialysis patients in Japan has been increasing because of a severe lack of donors. Parathyroid glands of long-term dialysis patients often show qualitative morphological changes from diffuse to nodular hyperplasia. Only a few studies have reported the clinicopathological analysis of persistent hyperparathyroidism after kidney transplantation in long-term (>10 years) dialysis patients. This study on consecutive deceased donor kidney transplantation performed from 2002 to 2010 measured biochemical parameters related to bone and mineral disorders and examined parathyroid tissues in parathyroidectomy cases...
October 2013: Therapeutic Apheresis and Dialysis
Hironobu Nobata, Yoshihiro Tominaga, Hirokazu Imai, Kazuharu Uchida
BACKGROUND: After renal transplantation (RTX), hypercalcemia, mainly due to persistent hyperparathyroidism, and hypophosphatemia, caused by the improved ability to excrete phosphorus in the renal tubules, are expected. However, immediately after RTX, a transient reduction in serum calcium (Ca) levels has been previously reported, the reason for which is not clear. PATIENTS AND METHODS: In 21 patients receiving ABO compatible living donor kidney transplants, serum levels of Ca, phosphorus, intact parathyroid hormone (iPTH), 1,25-dihydroxyvitamin D, and tacrolimus were measured within three wk after RTX, along with urinary Ca and phosphorus excretion...
November 2013: Clinical Transplantation
Catherine M Seager, Titte R Srinivas, Stuart M Flechner
BACKGROUND: Secondary hyperparathyroidism often accompanies chronic kidney disease, which can result in severe bone abnormalities and nephrolithiasis. Renal transplantation can correct the mineral abnormalities associated with chronic kidney disease, but one year after transplantation many recipients continue to exhibit persistent hyperparathyroidism. CASE REPORT: Cinacalcet, a second-generation calcimimetic, has been shown to be effective in decreasing serum calcium levels in post kidney transplant patients with hyperparathyroidism...
2013: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Sartaj Alam, Asrar Hussain, Rajendra Daiwajna, Jackson Tan
INTRODUCTION: Sevelamer hydrochloride (Renagel) is frequently used as a second-line phosphate binder in patients on renal replacement therapy. Many studies have shown that sevelamer can improve vascular calcification, serum uric acid and low-density lipoprotein (LDL) cholesterol levels. The main objectives of this study were to assess the efficacy of sevelamer against calcium-based phosphate binders, as well as its tolerability and side-effect profile. METHODS: This was a retrospective study that included all patients on renal replacement therapy (between 2008 and 2011) who had previously received calcium-based binders for ≥ 6 months and were subsequently switched to sevelamer...
May 2013: Singapore Medical Journal
Michael T Burke, Peter R Hollett, Nicholas A Gray
Bone disease is a major cause of morbidity post renal transplantation. The authors present a case of adynamic bone disease and atypical fractures associated with the use of bisphosphonates following renal transplantation. The uncertain role of parathyroidectomy and bone mineral density scans is also reviewed.
April 2012: Nephrology
J Van de Cauter, J Sennesael, P Haentjens
BACKGROUND: Abnormalities in bone and mineral metabolism are common after renal transplantation (RT) but information on their long-term time course is scarce. OBJECTIVES: (1) Evaluate the time course of biochemical parameters of bone and mineral metabolism over 60 months after RT; (2) identify predictors for persistent hyperparathyroidism (HPT). DESIGN: Prospective, longitudinal, single-center cohort study. METHODS: We determined serum levels (mean values ± standard deviations) of intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase (APh), calcitriol, and creatinine (Cr) preoperatively as well as 6, 12, 24, 36, 48, and 60 months after cadaveric RT in 49 patients...
November 2011: Transplantation Proceedings
Hazim M Sadideen, John D Taylor, David J Goldsmith
INTRODUCTION: Renal transplant patients are unique in that bone changes occur on a background of pre-existing chronic kidney disease-mineral bone disorder. In a few cases, there is overt hyperparathyroidism manifested by hypercalcaemia. Traditionally, if severe or persistent, this is treated by parathyroidectomy. At our unit, the default surgical operation is total parathyroidectomy without autotransplantation. METHODS: Patient charts for the last three decades were reviewed retrospectively...
February 2012: International Urology and Nephrology
Hiroo Kawarazaki, Yugo Shibagaki, Seiji Fukumoto, Ryo Kido, Katsuyuki Ando, Ichiro Nakajima, Shohei Fuchinoue, Toshiro Fujita, Masafumi Fukagawa, Satoshi Teraoka
Mineral and bone disorders (MBD), including hypercalcemia and hypophosphatemia, are common complications after renal transplantation; however, the natural course of these disorders has not been well documented, and the pathogenesis of persistent post-transplant MBD still remains elusive. This study was carried out to show the natural history of mineral metabolism in recipients after living-donor kidney transplantation and also to clarify post-transplant risk factors of persistent hypercalcemia and/or hypophosphatemia at 12months after transplantation...
October 2011: Therapeutic Apheresis and Dialysis
Henri Boulanger, Jean-Philippe Haymann, Bruno Fouqueray, Rafik Mansouri, Fabien Metivier, Lucile Mercadal, David Attaf, Martin Flamant, Denis Glotz
The purpose of the study is to assess the impact of cinacalcet on calcium and bone remodeling, in post-renal transplanted patients with persistent hypercalcaemia secondary to hyperparathyroidism. Thirteen renal-transplanted adult recipients with a glomerular filtration rate over 30 ml/min/1.73 m(2), a total serum calcium>2.60 mmol/l with ionized calcium>1.31 mmol/l and a parathyroid hormone serum level over 70 pg/ml, were treated with cinacalcet for 4 months followed by a 15-day wash out. The results show that cinacalcet lowers significantly total and ionized calcium respectively from 2,73 (2,67-2,86) to 2,31 (2,26-2,37) mmol/l (P<0...
February 2012: Néphrologie & Thérapeutique
Isabella Guzzo, Giacomo Di Zazzo, Chiara Laurenzi, Lucilla Ravà, Germana Giannone, Stefano Picca, Luca Dello Strologo
Secondary hyperparathyroidism is a common complication of chronic renal failure. Kidney transplantation corrects renal insufficiency and most metabolic abnormalities but hyperparathyroidism persists in 50% of children after transplantation. The aim of this study was to investigate parathyroid hormone (PTH) course and potential risk factors for hyperparathyroidism in children after renal transplant. We collected data from 145 transplanted children (mean follow-up 4.7 years). Intact PTH level (iPTH) rapidly decreased in the first 6 months post-transplant and continued to decline in the following years...
November 2011: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Ali Derakhshan, Afshin G Behbahan, Mehrzad Lotfi, Gholam-Hossein Omrani, Mohammad-Hossein Fallahzadeh, Mitra Basiratnia, Ghamar H Al-Hashemi
Incomplete resolution of abnormalities of mineral metabolism associated with CRF results in the relatively high prevalence of ROD in pediatric kidney recipients. This non-randomized, cross-sectional, and analytic-descriptive study on bone density, vitamin D, and mineral metabolism was performed in 57 children and adolescents who had received a total of 60 renal allografts in Shiraz, Iran. The height and weight of the patients were measured; their serum calcium (Ca), phosphorus (P), Alk-P, PTH, 25(OH)-vitamin D(3), BUN, creatinine, and electrolyte levels were analyzed, and a complete blood count was performed...
June 2011: Pediatric Transplantation
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