Lupica R, Buemi M, Campennì A, Trimboli D, Canale V, Cernaro V, Santoro D. Unexpected hypercalcemia in a diabetic patient with kidney disease. World J Nephrol 2015; 4(3): 438-443 [PMID: 26167468 DOI: 10.5527/wjn.v4.i3.438]
Corresponding Author of This Article
Domenico Santoro, Medical Researcher, Department of Clinical and Experimental Medicine, Division of Nephrology and Dialysis, University of Messina AOU G. Martino, Via Consolare Valeria n°1, 98100 Messina, Italy. santisi@hotmail.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rosaria Lupica, Michele Buemi, Domenico Trimboli, Valeria Canale, Valeria Cernaro, Domenico Santoro, Department of Clinical and Experimental Medicine, Division of Nephrology and Dialysis, University of Messina, AOU G. Martino CAP, 98100 Messina, Italy
Alfredo Campennì, Nuclear Medicine Unit, Department of Biomedical Science and of Morphological and Functional Images, University of Messina, AOU G. Martino, 98100 Messina, Italy
Author contributions: Lupica R, Buemi M and Santoro D designed the report; Santoro D performed the biopsy analyses; Trimboli D, Canale V, Cernaro V and Campennì A collected the patient’s clinical data; Lupica R analyzed the data and wrote the paper.
Ethics approval statement: The study was reviewed and approved by the Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no relevant financial interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Domenico Santoro, Medical Researcher, Department of Clinical and Experimental Medicine, Division of Nephrology and Dialysis, University of Messina AOU G. Martino, Via Consolare Valeria n°1, 98100 Messina, Italy. santisi@hotmail.com
Telephone: +39-090-2212331 Fax: +39-090-2212317
Received: November 13, 2014 Peer-review started: November 13, 2014 First decision: December 26, 2014 Revised: January 14, 2015 Accepted: April 28, 2015 Article in press: April 30, 2015 Published online: July 6, 2015 Processing time: 235 Days and 11.4 Hours
Abstract
We report a case of a diabetic patient with progressive chronic kidney disease and unexplained hypercalcemia. This unusual presentation and the investigation of all possible causes led us to perform a renal biopsy. The systemic sarcoidosis diagnosis was confirmed by the presence of interstitial multiple granulomas composed of epithelioid and multinucleated giant cells delimited by a thin fibrous reaction, and by pulmonary computed tomography finding of numerous lumps with ground-glass appearance. Sarcoidosis most commonly involves lungs, lymph nodes, skin and eyes, whilst kidney is less frequently involved. When it affects males it is characterized by hypercalcemia, hypercalciuria, and progressive loss of renal function. Early treatment with steroids allows for a gradual improvement in renal function and normalization of calcium serum values. Otherwise, the patient would quickly progress to end stage renal disease. Finding of hypercalcemia in a patient with renal failure must alert physicians because it may be a sign of several pathological entities.
Core tip: This report not only describes a case of kidney sarcoidosis, but also explains the diagnostic algorithm that led to the correct diagnosis of a case wrongly labelled as chronic kidney disease (CKD) secondary to diabetic nephropathy. The absence of other microangiopathic alterations such as retinopathy and secondly the presence of hypercalcemia with hypoparathyroidism in a patient with CKD need to be further explored.