Unusual case of hypercalcemia in a patient with primary steroid-resistant nephrotic syndrome

Česká verzia

Authors: Ľ. Kováčiková ml.; Ľ. Tichá; M. Chocholová; Ľ. Podracká
Authors place of work: Detská klinika Lekárskej fakulty Univerzity Komenského a Detskej fakultnej nemocnice s poliklinikou, Bratislava
Published in the journal: Čes-slov Pediat 2017; 72 (1): 39-44.
Category: Case Report

Summary

Calcium homeostasis imbalance occurs frequently in patients with nephrotic syndrome. Characteristic finding is hypocalcemia that is usually a result of severe hypoalbuminemia (pseudohypocalcemia). Other contributing factor is a urinary loss of vitamin D binding proteins with subsequent vitamin D deficiency that decreases intestinal calcium absorption.

We describe the unusual case of hypercalcemia in a 12-year old girl with primary steroid-resistant nephrotic syndrome caused by focal segmental glomerulosclerosis. The patient was treated with corticosteroids and multiple 2-line imunosupressive medications without achievement of complete remission. Hypercalcemia was unexpected finding at the state of fully developed laboratory signs of nephrotic syndrome. Hypercalcemia persisted despite discontinuation of vitamin D and calcium supplementation administered for corticosteroid induced osteoporosis. Ultrasonography and positron emission tomography of parathyroid glands raised suspicion for parathyroid adenoma. Histological evaluation following adenoma exstirpation confirmed the diagnosis.

Key words:
nephrotic syndrome, hypercalciemia, parathyroid adenoma

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