Rapid onset intratubular calcification following renal transplantation requiring urgent parathyroidectomy.
BACKGROUND
Secondary hyperparathyroidism is a common complication of end-stage renal disease often requiring parathyroidectomy. Renal transplant with the restoration of normal renal function often allows resolution of hyperparathyroidism, avoiding the need for parathyroid surgery. However, a proportion of patients with hyperparathyroidism become overtly hypercalcemic after renal transplantation which poses management dilemmas between medical and surgical treatment.


METHODS
We present the case of a 48-yearold man with end-stage renal failure known to have secondary hyperparathyroidism who received a living related renal transplant. Postoperatively he developed prompt hypercalcemia, polyuria, polydipsia and rapid onset intratubular calcification, leading to acute tubular necrosis diagnosed on renal biopsy on Day 7 post transplantation. He underwent surgical parathyroidectomy with resolution of his hypercalcemia and improved renal transplant function.


CONCLUSIONS
This case emphasizes the need for good management of secondary hyperparathyroidism together with close surveillance of PTH in patients awaiting renal transplantation. With good renal transplant function hyperparathyroidism usually resolves. Posttransplant surgical parathyroidectomy should be reserved for severe progressive end organ damage.
Sewpaul
A
A
Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Sayer
J A
JA
Mohamed
M A S
MA
Ahmed
A
A
Shaw
M
M
Prabhu
V R
VR
Wood
K
K
Jones
N A
NA
Talbot
D
D
Kanagasundaram
N S
NS
D002114:Calcinosis / Q000209:etiology* / Q000601:surgery*; D004638:Emergency Treatment; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D007674:Kidney Diseases / Q000209:etiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007684:Kidney Tubules; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D013997:Time Factors