[Hypercalcemia in a female patient with chronic kidney failure secondary to sarcoidosis: a metabolic study of the calcium metabolism and bone histology].
We describe the case of a 42-year-old woman diagnosed of chronic renal failure secondary to sarcoidosis. Since the beginning of the dialysis treatment she presented episodes of symptomatic hypercalcemia which did not response to calcium restriction diet and a lower calcium concentration in the dialysate. Secondary hyperparathyroidism and aluminium intoxication were biochemically ruled out. Hypercalcemic crisis were associated to 1.25-dihydroxy-vitamin D (1.25-D) serum levels abnormally raised and they responded quickly to low doses of corticosteroids. Subsequently, this treatment had to be withdrawn because of upper gastrointestinal bleeding, and hypercalcemia recurred. Chloroquine phosphate was prescribed with a rapid response to normalize the serum calcium levels. No side effects was recorded. Twelve months later of chloroquine therapy, the patient remained normocalcemic. A bone biopsy showed an active osteopenia without aluminium deposits, hyperparathyroidism signs or granuloma. We discuss about the pathogenesis of hypercalcemia in this case and its relation with abnormal high serum levels of 1.25-D in hemodialysis patients and sarcoidosis.
Caravaca
F
F
Servicio de Nefrología, Hospital Infanta Cristina, Badajoz.
Cubero
J J
JJ
de Francisco
A L
AL
Arrobas
M
M
Pizarro
J L
JL
Sánchez-Casado
E
E
D000328:Adult; D001706:Biopsy; D002118:Calcium / Q000097:blood*; D004100:Dihydroxycholecalciferols / Q000097:blood; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood* / Q000209:etiology / Q000473:pathology; D007085:Ilium / Q000473:pathology*; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006435:Renal Dialysis; D012507:Sarcoidosis / Q000097:blood* / Q000150:complications / Q000473:pathology
D004100:Dihydroxycholecalciferols; D002118:Calcium
Hipercalcemia en una paciente con insuficiencia renal crónica secundaria a sarcoidosis: estudio del metabolismo cálcico e histología ósea.