Abstract
A 64-year-old man was hospitalized in 2002 with symptoms of stupor, weakness, and renal colic. The clinical examination indicated borderline hypertension, small masses in the glutei, and polyuria. Laboratory tests evidenced high serum concentrations of creatinine, calcium, and phosphate. Imaging assessments disclosed widespread vascular calcifications, gluteal calcifications, and pelvic ectasia. Subsequent lab tests indicated suppressed serum parathyroid hormone, extremely high serum 25-hydroxy vitamin D, and normal serum 1,25-dihydroxy vitamin D. Treatment was started with intravenous infusion of saline and furosemide due to the evidence of hypercalcemia. Prednisone and omeprazole were added given the evidence of hypervitaminosis D. The treatment improved serum calcium, kidney function, and consciousness. The medical history disclosed recent treatment with exceptionally high doses of slow-release intra-muscular cholecalciferol and the recent excretion of urinary stones. The patient was discharged when it was possible to stop the intravenous treatment. The post-discharge treatment included oral hydration, furosemide, prednisone and omeprazole for approximately 6 months up to complete resolution of the hypercalcemia. The patient came back 12 years later because of microhematuria. Lab tests were normal for calcium/phosphorus homeostasis and kidney function. Imaging tests indicated only minor vascular calcifications. This is the first evidence of reversible vascular calcifications secondary to hypervitaminosis D.
References
Kovacic JC, Moreno P, Nabel EG, Hachinski V, Fuster V (2011) Cellular senescence, vascular disease, and aging. Circulation 123:1900–1910
Amann K (2008) Media calcification and intima calcification are distinct entities in chronic kidney disease. Clin J Am Soc Nephrol 3:1599–1605
Kendrick J, Chonchol M (2011) The role of phosphorus in the development and progression of vascular calcification. Am J Kidney Dis 58:826–834
Duranton F, Rodriguez-Ortiz ME, Duny Y, Rodriguez M, Daurès JP, Argilés A (2013) Vitamin D treatment and mortality in chronic kidney disease: a systematic review and meta-analysis. Am J Nephrol 37:239–248
Niederhoffer N, Bobryshev YV, Lartaud-Idjouadiene I, Giummelly P, Atkinson J (1997) Aortic calcification produced by vitamin D3 plus nicotine. J Vasc Res 34:386–398
Bas A, Lopez I, Perez J, Rodriguez M, Aguilera-Tejero E (2006) Reversibility of calcitriol-induced medial artery calcification in rats with intact renal function. J Bone Miner Res 21:484–490
Kerr DNS (1997) Hypercalcemia and metastatic calcification. Cardiovasc Res 36:293–297
Davies MD, Mawer EB, Freemont AJ (1986) The osteodystrophy of hypervitaminosis D: a metabolic study. Q J Med 61:911–919
Kanis JA, Russell RGG (1977) Rate of reversal of hypercalcaemia and hypercalciuria induced by vitamin D and its 1α-hydroxylated derivatives. Br Med J 1:78
Butler RC, Dieppe PA, Keat ACS (1985) Calcinosis of joints and periarticular tissues associated with vitamin D intoxication. Ann Rheum Dis 44:494–498
Sato K, Emoto N, Toraya S, Tsushima T, Demura H, Tsuji N, Inaba S, Takeuchi A, Kobayashi T (1994) Progressively increased 1,25-dihydroxyvitamin D2 concentration in a hypoparathyroid patient with protracted hypercalcemia due to vitamin D2. Endocr J 41:329–337
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All procedures performed in studies involving the patient included in the case report were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Cirillo, M., Bilancio, G. & Cirillo, C. Reversible vascular calcifications associated with hypervitaminosis D. J Nephrol 29, 129–131 (2016). https://doi.org/10.1007/s40620-015-0228-7
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DOI: https://doi.org/10.1007/s40620-015-0228-7