A Case of Severe Hypercalcemia Causing Acute Kidney Injury: An Unusual Presentation of Acute Lymphoblastic Leukemia

다국어 초록 (Multilingual Abstract)

Severe hypercalcemia is rarely encountered in children, even though serum calcium concentrations above 15-16 mg/dL could be life-threatening. We present a patient having severe hypercalcemia and azotemia. A 14-year-old boy with no significant past medical history was referred to our hospital with hypercalcemia and azotemia. Laboratory and imaging studies excluded hyperparathyroidism and solid tumor. Other laboratory findings including a peripheral blood profile were unremarkable. His hypercalcemia was not improved with massive hydration, diuretics, or even hemodialysis, but noticeably reversed with administration of calcitonin. A bone marrow biopsy performed to rule out the possibility of hematological malignancy revealed acute lymphoblastic leukemia. His hypercalcemia and azotemia resolved shortly after initiation of induction chemotherapy. Results in this patient indicate that a hematological malignancy could present with severe hypercalcemia even though blast cells have not appeared in the peripheral blood.
Therefore, extensive evaluation to determine the cause of hypercalcemia is necessary.
Additionally, appropriate treatment, viz., hydration or administration of calcitonin is important to prevent complications of severe hypercalcemia, including renal failure and nephrocalcinosis.

참고문헌 (Reference)

1 Ravi C, "Textbook of Clinical Pediatrics" Springer 3611-3616, 2012

2 Shu ST, "T-cell Leukemia" InTech 181-194, 2002

3 Wisneski LA, "Salmon calcitonin in hypercalcemia" 24 : 219-222, 1978

4 Riccardi D, "Physiology and pathophysiology of the calcium-sensing receptor in the kidney" 298 : F485-F499, 2010

5 Rosner MH, "Onco-nephrology: The pathophysiology and treatment of malignancy-associated hypercalcemia" 7 : 1722-1729, 2012

6 Makras P, "Medical treatment of hypercalcaemia" 8 : 83-95, 2009

7 Davies JH, "Investigation and management of hypercalcaemia in children" 97 : 533-538, 2012

8 Takami H, "Hypercalcemic crisis" 543-548, 2005

9 McKay C, "Hypercalcemia complicating childhood malignancies" 72 : 256-260, 1993

10 Stewart AF, "Hypercalcemia associated with cancer" 352 : 373-379, 2005

11 Mundy GR, "Hormonal control of calcium homeostasis" 45 : 1347-1352, 1999

12 Rogers MJ, "Cellular and molecular mechanisms of action of bisphosphonates" 88 : 2961-2978, 2000

13 Argilés a, "Calcium kinetics and the long-term effects of lowering dialysate calcium concentration" 43 : 630-640, 1993

14 Toussaint ND, "Bisphosphonates in chronic kidney disease; balancing potential benefits and adverse effects on bone and soft tissue" 4 : 221-233, 2009

15 Hasler U, "Aquaporin-2 abundance in the renal collecting duct: new insights from cultured cell models" 297 : F10-F18, 2009