Reversal of hypercalcemic acute kidney injury by treatment with intravenous bisphosphonates

Abstract

We present the details of three children with hypercalcemia-induced acute kidney injury (AKI). After traditional therapy with fluids, loop diuretics, steroids and calcitonin had failed to correct the hypercalcemia, they were given treatment with low doses of intravenous (i.v.) pamidronate, which resulted in normalization of serum calcium and kidney function. In one child Doppler renal ultrasound revealed dampened arterial blood flow, which resolved with normalization of serum calcium. On the basis of cumulative data and our experience, we suggest that i.v. application of bisphosphonates be moved from the second to the first line of treatment of hypercalcemic AKI.

Resection of granulomatous tissue resolves silicone induced hypercalcemia

“…It is unclear whether this is coincidental or has pathophysiologic significance. Untreated or chronic hypercalcemia can have a deleterious effect on renal function, lead to acute kidney injury, nephrolithiasis — as was seen in these cases (Auron et al, 2009, Schulze, 1982). Resolution of hypercalcemia in case 1 resulted in recovery of renal function.…”

Milk alkali syndrome in an infant with chronic kidney disease

“…12 In children, hypercalcemia was reported to be associated with acute kidney injury in two immobilized children and a third child with malignancy. 13 However, milk alkali syndrome as a cause of hypercalcemia or acute kidney injury has not been reported before in children. Abnormalities in serum calcium concentration may have profound effects on the neurological and gastrointestinal systems as well as on renal function.…”

Bisphosphonates Use in Children

“…Case reports in the pediatric literature also support the beneficial effect of such treatment. 80 Moreover, as some patients develop acute renal failure secondary to the hypercalcemia, the treatment with bisphosphonates reverses this condition as well. 80 It is important to remember though that hypercalcemia also causes dehydration, and therefore adequate hydration continues to be an important element in the treatment of these patients, often accompanied by furosemide for its diuretic and calciuric properties.…”

“…80 Moreover, as some patients develop acute renal failure secondary to the hypercalcemia, the treatment with bisphosphonates reverses this condition as well. 80 It is important to remember though that hypercalcemia also causes dehydration, and therefore adequate hydration continues to be an important element in the treatment of these patients, often accompanied by furosemide for its diuretic and calciuric properties. 80 Our experience shows that these children are highly responsive to the bisphosphonate treatment and therefore half the usual dose is needed, and if renal failure is present the dose should be further halved, thus ending in 0.25 mg/kg.…”