title: Successful treatment of early allograft dysfunction with cinacalcet in a patient with nephrocalcinosis caused by severe hyperparathyroidism: a case report.
abstract: BACKGROUND
  Hyperparathyroidism is common in patients undergoing kidney transplantation. Occasionally, this condition can cause early allograft dysfunction by inducing calcium phosphate deposition in the allograft, which results in nephrocalcinosis. Although nephrocalcinosis occurs occasionally in kidney allografts, it has only rarely been reported in the literature.
  
  
  METHODS
  Here, we present the case of a 58-year-old Thai woman with severe hyperparathyroidism who received a living-related kidney transplant from her 35-year-old son. Our patient developed allograft dysfunction on day 2 post-transplantation despite good functioning graft on day 1. Allograft biopsy showed extensive calcium phosphate deposition in distal tubules. She was treated with cinacalcet (a calcimimetic agent) and aluminum hydroxide. Allograft function was restored to normal within 1 week after transplantation with greatly reduced intact parathyroid hormone level.
  
  
  CONCLUSIONS
  Hyperparathyroidism in early functioning allograft causes elevated calcium and phosphate concentration in distal tubules resulting in nephrocalcinosis. The massive calcium phosphate precipitation obstructs tubular lumens, which leads to acute tubular dysfunction. Treatment of nephrocalcinosis with cinacalcet is safe and may improve this condition by increasing serum phosphate and reducing serum calcium and intact parathyroid hormone.
authors.affiliation: Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok, 10700, Thailand. boonyarit.che@mahidol.ac.th.
authors.forename: Boonyarit
authors.initials: B
authors.lastname: Cheunsuchon
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Suchai
authors.initials: S
authors.lastname: Sritippayawan
mesh_terms: D000328:Adult; D064591:Allografts; D057966:Calcimimetic Agents / Q000627:therapeutic use; D002130:Calcium Phosphates / Q000378:metabolism; D000069449:Cinacalcet / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications*; D016030:Kidney Transplantation / Q000379:methods*; D007686:Kidney Tubules, Distal / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009397:Nephrocalcinosis / Q000188:drug therapy* / Q000209:etiology; D009679:Nuclear Family; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D057966:Calcimimetic Agents; D002130:Calcium Phosphates; C020243:calcium phosphate; D000069449:Cinacalcet
keywords: Case report; Cinacalcet; Early allograft dysfunction; Hyperparathyroidism; Nephrocalcinosis