Hypercalcemia and Renal failure: Mechanism

Calcium homeostasis is normally under very tight control! There are 3 main sites of control: the gastrointestinal tract, bone, and kidney.

Hypercalcemia can happen for a variety of reasons (Multiple myeloma, cancer, Sarcoidosis, hyperparathyroidism, Milk-alkali syndrome, vitamin D intoxication etc.)

Subsequently acute renal failure may develop in the context of this pathology for several reasons.

HOW??

• Polyuria during the hypercalcemia may cause hypovolemia and pre-renal AKI.
• Vaso-constrictive effects of calcium. An increased influx of calcium into the vascular smooth muscle cells leads to an augmented muscular tone. Therefore increased vascular resistance and reduced renal perfusion.
• Hypercalcemic nephrolithiasis. Formation of Ca2+-Oxalate stones, potentially causing obstruction and renal insufficiency.

REFERENCES

1. Moysés-Neto M et al. Acute renal failure and hypercalcemia. Ren Fail. 2006;28(2):153-9.
2. Simonetti G. Calcium and blood pressure. Ther Umsch. 2007 May;64(5):249-52.
3. Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003 May 1;67(9):1959-66.
4. Parks J, Coe F, Favus M. Hyperparathyroidism in Nephrolithiasis. Arch Intern Med. 1980;140(11):1479-1481.