Acute renal failure due to hypercalcemia-related nephrocalcinosis in a patient of non-Hodgkin's lymphoma featuring swelling of bilateral kidneys.

摘要

Dear Editor,Hypercalcemia is not uncommon in lymphoma patients. But complications with acute renal failure and nephrocalcinosis after stem cell transplantation are not reported before. We describe a woman with lymphoma experiencing acute renal failure after successful autologous peripheral blood stem cell transplantation because of hypercalcemia and nephrocalcinosis.In March, 2006, a 46-year-old woman was admitted because of intractable dizziness, nausea, vomiting, and poor appetite for 1 week. She had a history of diffuse large B-cell lymphoma, initial stage IVB, with lung and bone marrow involvement diagnosed in May, 2005. A clinical complete remission was achieved after eight cycles of standard rituximab, cyclophosphamide, doxorubicin, vincristine, and Prednisolone (R-CHOP). High-dose chemotherapy with autologous peripheral blood stem cell transplantation was performed in January 2006. Physical examination was unremarkable. Laboratory tests revealed hypercalcemia of 15.3 mg/dl (normal 8.4-10.2). Shedeveloped acute oliguric renal failure (ARF) with increased BUN (303 mg/dl, normal: 7.0-20.0) and serum creatinine(3.9 mg/dl, normal: 0.7-1.2). Meanwhile, reduced serum intact parathyroid hormone [iPTH; less man 1.0 pg/dl (normal: 12.6-57.5)] and 1,25-dihydroxyvitamin D3 [less than 5.0 pg/dl (normal: 15.9-55.6)], undetectable PTH-related peptide (PTHrP), and elevated interleukin (IL)-6 (265 pg/mL [normal: 0-20.0]) were found.