Acquired Hypocalciuric Hypercalcemia in a Patient With CKD

被引：8

作者：

Kuo, Elizabeth ^{[1
]}

Kemp, E. Helen ^{[2
]}

Sandhu, Harpreet K. ^{[2
]}

Brown, Edward M. ^{[3
,4
]}

Weetman, Anthony P. ^{[2
]}

Huang, Chou-Long ^{[1
]}

机构：

[1] Univ Texas SW Med Ctr Dallas, Dept Med, Div Nephrol, Dallas, TX 75390 USA

[2] Univ Sheffield, Dept Human Metab, Sch Med, Sheffield, S Yorkshire, England

[3] Brigham & Womens Hosp, Dept Med, Div Endocrinol Diabet & Hypertens, Boston, MA 02115 USA

[4] Harvard Univ, Sch Med, Boston, MA USA

来源：

AMERICAN JOURNAL OF KIDNEY DISEASES | 2013年 / 62卷 / 06期

关键词：

Autoimmune hypocalciuric hypercalcemia; calcium-sensing receptor; hyperparathyroidism; autoantibody; CALCIUM-SENSING RECEPTOR; AUTOANTIBODIES; HYPERPARATHYROIDISM; HYPOPARATHYROIDISM;

D O I：

10.1053/j.ajkd.2013.04.023

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

We present a case of an 82-year-old woman with elevated parathyroid hormone (PTH) levels, hypocalciuria, hypercalcemia, and stage 3 chronic kidney disease. Hypocalciuria initially was attributed to chronic kidney disease, and hypercalcemia was attributed to primary hyperparathyroidism. Subsequent laboratory studies showed autoantibodies in the patient's serum directed against the calcium-sensing receptor (CaSR). Functional testing in a CaSR-transfected human embryonic kidney-293 cell line showed that the patient's antibodies inhibited CaSR-mediated intracellular signaling that ordinarily would have been stimulated by extracellular calcium ions. Her serum calcium and PTH levels were normalized by treatment with the calcimimetic cinacalcet. We advise consideration of the presence of inhibitory autoantibodies directed at the CaSR in patients with hypercalcemic hyperparathyroidism and unexplained hypocalciuria or with confounding conditions affecting interpretation of urinary calcium measurement. A calcimimetic is an effective treatment for the hypercalcemia and elevated PTH levels in acquired hypocalciuric hypercalcemia caused by inhibitory anti-CaSR autoantibodies. (C) 2013 by the National Kidney Foundation, Inc.

引用

页码：1151 / 1154

页数：4

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