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The effect of hypercalcemia on allograft calcification after kidney transplantation

  • Nephrology - Original Paper
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Abstract

Purpose

Persistent hypercalcemia after kidney transplantation (KTx) may cause nephrocalcinosis and graft dysfunction. The aim of this study was to evaluate patients with hypercalcemia and assess its effect on tubulointerstitial calcification.

Methods

A total of 247 recipients were enrolled. Transient and persistent hypercalcemia was defined as hypercalcemia (corrected serum calcium >10.2 mg/dL) persisting for 6 and 12 months after KTx, respectively. The severity of calcification in the 0-h, 6- and 12-month protocol biopsies of patients with transient (n = 8) and persistent hypercalcemia (n = 20) was compared with a matched control group (n = 28).

Results

Twenty-eight patients were hypercalcemic at 6 months posttransplantation. Serum calcium levels were normalized in eight of them at the end of the first year. Dialysis duration was a positive predictor of persistent hypercalcemia. Tubulointerstitial calcification was detected in 70.6 and 90 % of patients with persistent hypercalcemia at 6 and 12 months posttransplantation, respectively. In 20 % of patients with transient hypercalcemia, severity of calcification regressed at 12 months posttransplantation along with normalization of serum calcium levels. Graft functions and histopathological findings (ci, ct, ci + ct, cv, ah, percentage of sclerotic glomeruli) were not different at 6 and 12 months posttransplantation.

Conclusions

Hypercalcemia and persistent hyperparathyroidism are not rare after KTx. Tubulointerstitial calcification is more common and progressive among patients with persistent hypercalcemia. Normalization of calcium levels may contribute to regression of calcification in some patients.

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References

  1. Herlitz LC, D’Agati VD, Markowitz GS (2012) Crystalline nephropathies. Arch Pathol Lab Med 136:713–720

    Article  PubMed  Google Scholar 

  2. Wiech T, Hopfer H, Gaspert A, Banyai-Falger S, Hausberg M, Schroder J, Werner M, Mihatsch MJ (2012) Histopathological patterns of nephrocalcinosis: a phosphate type can be distinguished from a calcium type. Nephrol Dial Transplant 27:1122–1131

    Article  CAS  PubMed  Google Scholar 

  3. Boom H, Mallat MJ, de Fijter JW, Paul LC, Bruijn JA, van Es LA (2004) Calcium levels as a risk factor for delayed graft function. Transplantation 77:868–873

    Article  CAS  PubMed  Google Scholar 

  4. Nankivell BJ, Borrows RJ, Fung CL, O’Connell PJ, Allen RD, Chapman JR (2003) The natural history of chronic allograft nephropathy. N Engl J Med 349:2326–2333

    Article  CAS  PubMed  Google Scholar 

  5. Gwinner W, Suppa S, Mengel M, Hoy L, Kreipe HH, Haller H, Schwarz A (2005) Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J Transplant 5:1934–1941

    Article  PubMed  Google Scholar 

  6. Evenepoel P, Lerut E, Naesens M, Bammens B, Claes K, Kuypers D, Vermeersch P, Meijers B, Van Damme B, Vanrenterghem Y (2009) Localization, etiology and impact of calcium phosphate deposits in renal allografts. Am J Transplant 9:2470–2478

    Article  CAS  PubMed  Google Scholar 

  7. Ozdemir FN, Afsar B, Akgul A, Usluogullari C, Akcay A, Haberal M (2006) Persistent hypercalcemia is a significant risk factor for graft dysfunction in renal transplantation recipients. Transplant Proc 38:480–482

    Article  CAS  PubMed  Google Scholar 

  8. Schwarz A, Mengel M, Gwinner W, Radermacher J, Hiss M, Kreipe H, Haller H (2005) Risk factors for chronic allograft nephropathy after renal transplantation: a protocol biopsy study. Kidney Int 67:341–348

    Article  PubMed  Google Scholar 

  9. Messa P, Cafforio C, Alfieri C (2011) Clinical impact of hypercalcemia in kidney transplant. Int J Nephrol 2011:906832

    Article  PubMed  PubMed Central  Google Scholar 

  10. Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, Croker BP, Demetris AJ, Drachenberg CB, Fogo AB, Furness P, Gaber LW, Gibson IW, Glotz D, Goldberg JC, Grande J, Halloran PF, Hansen HE, Hartley B, Hayry PJ, Hill CM, Hoffman EO, Hunsicker LG, Lindblad AS, Yamaguchi Y et al (1999) The banff 97 working classification of renal allograft pathology. Kidney Int 55:713–723

    Article  CAS  PubMed  Google Scholar 

  11. Torres A, Lorenzo V, Salido E (2002) Calcium metabolism and skeletal problems after transplantation. J Am Soc Nephrol 13:551–558

    PubMed  Google Scholar 

  12. Heaf J, Tvedegaard E, Kanstrup IL, Fogh-Andersen N (2003) Hyperparathyroidism and long-term bone loss after renal transplantation. Clin Transplant 17:268–274

    Article  PubMed  Google Scholar 

  13. Egbuna OI, Taylor JG, Bushinsky DA, Zand MS (2007) Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure. Clin Transplant 21:558–566

    Article  PubMed  Google Scholar 

  14. Evenepoel P, Van Den Bergh B, Naesens M, De Jonge H, Bammens B, Claes K, Kuypers D, Vanrenterghem Y (2009) Calcium metabolism in the early posttransplantation period. Clin J Am Soc Nephrol 4:665–672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Leca N, Laftavi M, Gundroo A, Kohli R, Min I, Karam J, Sridhar N, Blessios G, Venuto R, Pankewycz O (2006) Early and severe hyperparathyroidism associated with hypercalcemia after renal transplant treated with cinacalcet. Am J Transplant 6:2391–2395

    Article  CAS  PubMed  Google Scholar 

  16. Reinhardt W, Bartelworth H, Jockenhovel F, Schmidt-Gayk H, Witzke O, Wagner K, Heemann UW, Reinwein D, Philipp T, Mann K (1998) Sequential changes of biochemical bone parameters after kidney transplantation. Nephrol Dial Transplant 13:436–442

    Article  CAS  PubMed  Google Scholar 

  17. Evenepoel P, Claes K, Kuypers D, Maes B, Bammens B, Vanrenterghem Y (2004) Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study. Nephrol Dial Transplant 19:1281–1287

    Article  CAS  PubMed  Google Scholar 

  18. Nakamura M, Tanaka K, Marui Y, Tomikawa S (2013) Clinicopathological analysis of persistent hypercalcemia and hyperparathyroidism after kidney transplantation in long-term dialysis patients. Ther Apher Dial 17:551–556

    CAS  PubMed  Google Scholar 

  19. Kim YJ, Kim MG, Jeon HJ, Ro H, Park HC, Jeong JC, Oh KH, Ha J, Yang J, Ahn C (2012) Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation. Transplant Proc 44:651–656

    Article  CAS  PubMed  Google Scholar 

  20. Iguchi S, Nishi S, Shinbo J, Iino N, Kazama JJ, Shimada H, Ueno M, Saitou K, Tanigawa T, Takahashi K, Gejyo F (2001) Intratubular calcification in a post-renal transplanted patient with secondary hyperparathyroidism. Clin Transplant 15(Suppl 5):51–54

    Article  PubMed  Google Scholar 

  21. Sewpaul A, Sayer JA, Mohamed MA, Ahmed A, Shaw M, Prabhu VR, Wood K, Jones NA, Talbot D, Kanagasundaram NS (2007) Rapid onset intratubular calcification following renal transplantation requiring urgent parathyroidectomy. Clin Nephrol 68:47–51

    Article  CAS  PubMed  Google Scholar 

  22. Pinheiro HS, Camara NO, Osaki KS, De Moura LA, Pacheco-Silva A (2005) Early presence of calcium oxalate deposition in kidney graft biopsies is associated with poor long-term graft survival. Am J Transplant 5:323–329

    Article  CAS  PubMed  Google Scholar 

  23. Habbig S, Beck BB, Feldkotter M, Korber F, Laffeber C, Verkoelen C, Mihatsch MJ, Hoppe B (2009) Renal allograft calcification–prevalence and etiology in pediatric patients. Am J Nephrol 30:194–200

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors also acknowledge that he or she participated sufficiently in the work to take public responsibility for its content. All authors gave final approval of the version to be published. The authors hereby confirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere, except in abstract form.

Author contributions

Aygül Çeltik participated in study design, data collection, interpretation of the results, writing of the article and patient management. Sait Şen performed pathological analysis of the allograft biopsies. Mümtaz Yılmaz participated in data collection and patient management. Meltem Seziş Demirci participated in data collection and patient management. Gülay Aşçı participated in data collection and interpretation of the results. Abdülkerim Furkan Tamer participated in data collection and patient management. Banu Sarsık participated in data collection and interpretation of the results. Cüneyt Hoşcoşkun participated in patient management and writing of the article. Hüseyin Töz participated in study design, data collection, interpretation of the results, writing of the article and patient management. Ercan Ok participated in interpretation of the results and writing of the article.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, 35100, Bornova, Izmir, Turkey

    Aygül Çeltik, Mümtaz Yılmaz, Meltem Seziş Demirci, Gülay Aşçı, Abdülkerim Furkan Tamer, Hüseyin Töz & Ercan Ok

  2. Department of Pathology, School of Medicine, Ege University, Bornova, Izmir, 35100, Turkey

    Sait Şen & Banu Sarsık

  3. Department of General Surgery, School of Medicine, Ege University, Bornova, Izmir, 35100, Turkey

    Cüneyt Hoşcoşkun

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  1. Aygül Çeltik
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  2. Sait Şen
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Correspondence to Hüseyin Töz.

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The authors declare that they have no conflict of interest.

Informed consent

All the biopsies and blood samples included in this study were performed according to our clinical follow-up and biopsy protocol. Since no additional biopsy or blood samples were taken for the purpose of this retrospective study, informed consent was not obtained from any individuals included in the study and approval of the ethics committee was not required.

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Çeltik, A., Şen, S., Yılmaz, M. et al. The effect of hypercalcemia on allograft calcification after kidney transplantation. Int Urol Nephrol 48, 1919–1925 (2016). https://doi.org/10.1007/s11255-016-1391-z

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  • DOI: https://doi.org/10.1007/s11255-016-1391-z

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