Hypercalcemia and Renal Complications Following High-Volume Polymethyl Methacrylate (PMMA) Injections: A Case Series

Background Polymethyl methacrylate (PMMA) is a permanent filler. It has been associated with hypercalcemia and renal complications when injected in large volumes. This study investigated cases of hypercalcemia, hypercalciuria, nephrolithiasis, and renal insufficiency that arise following PMMA injections. Methods A multicenter observational study was conducted involving Brazilian patients who developed hypercalcemia, hypercalciuria, nephrolithiasis, or renal insufficiency after PMMA injections in the gluteal region. The research explores clinical presentations, comorbidities, laboratory findings, imaging results, treatments and outcomes. Results Twelve women aged 23 to 70 years (mean: 44.3 years) received PMMA injections ranging from 150 to 900 mL (mean: 415 mL) in the gluteal region. The onset of complications varied, occurring from 40 days to eight years after the injection (mean onset: 27 months). All patients exhibited hypercalcemia or hypercalciuria, while renal dysfunction was observed in 83.3% of cases, and nephrolithiasis occurred in 50.0%. Laboratory test results revealed elevations in creatinine (83.3%), urea (75%), 1.25-OH vitamin D and ionized calcium (91.6%), and total calcium (66.6%). Parathyroid hormone (PTH) levels were supressed in 90% of patients, while 25-OH-vitamin D levels remained normal for all patients. Treatments included corticosteroids, denosumab, and bisphosphonates. Improvement of laboratory parameters was noted in two out of three patients following PMMA removal surgery. Elevated creatinine levels persisted in 83.3% of patients, indicating persistent renal dysfunction. Conclusion Injecting large volumes of PMMA poses a risk of significant hypercalcemia and renal complications. This study calls for stricter regulations regarding PMMA use and emphasizes the importance of long-term nephrological follow-ups. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.