Hypercalcemia after 1,25-Dihydroxyvitamin D<sub>3</sub> Production in an End-Stage Kidney
Authors: Robert W. Hedger, Eberechukwu Ibe, Arleen French
Journal: Annals of Internal Medicine (2003)

Letters18 March 2003Hypercalcemia after 1,25-Dihydroxyvitamin D3 Production in an End-Stage KidneyRobert W. Hedger, MD, Eberechukwu Ibe, MD, and Arleen French, BS, PARobert W. Hedger, MDNorthwestern University Medical School; Chicago, IL 60611 (Hedger)Resurrection Health Care/St. Joseph Hospital; Chicago, IL 60657 (Ibe)Associates in Nephrology; Chicago, IL 60611 (French)Search for more papers by this author, Eberechukwu Ibe, MDNorthwestern University Medical School; Chicago, IL 60611 (Hedger)Resurrection Health Care/St. Joseph Hospital; Chicago, IL 60657 (Ibe)Associates in Nephrology; Chicago, IL 60611 (French)Search for more papers by this author, and Arleen French, BS, PANorthwestern University Medical School; Chicago, IL 60611 (Hedger)Resurrection Health Care/St. Joseph Hospital; Chicago, IL 60657 (Ibe)Associates in Nephrology; Chicago, IL 60611 (French)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-6-200303180-00032 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: The physiologic characteristics of vitamin D are well documented. Final hydroxylation in the kidney, by 1- hydroxylase, forms the active metabolite 1,25-dihydroxyvitamin D3 (vitamin D3) (1, 2). Vitamin D3 production decreases as the glomerular filtration rate falls below 30 mL/min per 1.73 m2. In failed kidneys, vitamin D3 production ceases and serum levels approach zero (3). Macrophages may produce small amounts of vitamin D3, and granulomatous diseases and malignant lymphoma cells can produce enough vitamin D3 to cause hypercalcemia (4-7).Objective: To describe a patient with persistent hypercalcemia triggered by production of vitamin D3 in a ...References1. Holick MF. Vitamin D: Photobiology, Metabolism, Mechanism of Action, and Clinical Applications. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed. Philadelphia: Lippincott; 1999:92-8. Google Scholar2. Holick MF. Vitamin D and the kidney. Kidney Int. 1987;32:912-29. [PMID: 2828754] CrossrefMedlineGoogle Scholar3. Dusso A, Lopez-Hilker S, Lewis-Finch J, Grooms P, Brown A, Martin K, et al. . Metabolic clearance rate and production rate of calcitriol in uremia. Kidney Int. 1989;35:860-4. [PMID: 2709678] CrossrefMedlineGoogle Scholar4. Dusso A, Lopez-Hilker S, Rapp N, Slatopolsky E. Extra-renal production of calcitriol in chronic renal failure. Kidney Int. 1988;34:368-75. [PMID: 3172645] CrossrefMedlineGoogle Scholar5. Gkonos PJ, London R, Hendler ED. Hypercalcemia and elevated 1,25-dihydroxyvitamin D levels in a patient with end-stage renal disease and active tuberculosis. N Engl J Med. 1984;311:1683-5. [PMID: 6548798] CrossrefMedlineGoogle Scholar6. Barbour GL, Coburn JW, Slatopolsky E, Norman AW, Horst RL. Hypercalcemia in an anephric patient with sarcoidosis: evidence for extrarenal generation of 1,25-dihydroxyvitamin D. N Engl J Med. 1981;305:440-3. [PMID: 6894783] CrossrefMedlineGoogle Scholar7. Kantarjian HM, Saad MF, Estey EH, Sellin RV, Samaan NA. Hypercalcemia in disseminated candidiasis. Am J Med. 1983;74:721-4. [PMID: 6837596] CrossrefMedlineGoogle Scholar8. Cato A, Cady WW, Soltanek C, Qasawa B, Chang M, Stoll R. Effect of hemodialysis on the pharmacokinetics of 19-nor-1alpha,25-dihydroxyvitamin D2. Am J Kidney Dis. 1998;32:S55-60. [PMID: 9808144] CrossrefMedlineGoogle Scholar9. Piraino BM, Rault R, Greenberg A, Dominguez JH, Wallia R, Houck P, et al. . Spontaneous hypercalcemia in patients undergoing dialysis. Etiologic and therapeutic considerations. Am J Med. 1986;80:607-15. [PMID: 3963041] CrossrefMedlineGoogle Scholar10. Cozzolino M, Dusso AS, Slatopolsky E. Role of calcium-phosphate product and bone-associated proteins on vascular calcification in renal failure. J Am Soc Nephrol. 2001;12:2511-6. [PMID: 11675430] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Robert W. Hedger, MD; Eberechukwu Ibe, MD; Arleen French, BS, PAAffiliations: Northwestern University Medical School; Chicago, IL 60611 (Hedger)Resurrection Health Care/St. Joseph Hospital; Chicago, IL 60657 (Ibe)Associates in Nephrology; Chicago, IL 60611 (French) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 March 2003Volume 138, Issue 6Page: 522-523KeywordsCalciumHypercalcemiaInferior vena cavaKidneysMedical dialysisNephrectomyPhosphorusRenal failureVeinsVitamin D ePublished: 18 March 2003 Issue Published: 18 March 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...