Renal allograft failure in a hyperparathyroid patient following initiation of a calcimimetic

Nat Rev Nephrol. 2011 Apr;7(4):237-41. doi: 10.1038/nrneph.2010.169. Epub 2010 Dec 14.


Background: A 47-year-old man with a 6-year history of chronic dialysis for end-stage renal disease of unknown etiology presented for renal transplantation. While on dialysis, he had developed secondary hyperparathyroidism, which persisted after transplantation despite treatment with cinacalcet.

Investigations: Physical examination, serum and urine analysis, ultrasound of the renal transplant, renal biopsy, bone scintigraphy.

Diagnosis: Severe persistent hyperparathyroidism associated with mild hypercalcemia following renal transplantation. Initiation of a calcimimetic followed by fulminant graft failure. Extensive tubular calcinosis.

Management: Renal transplantation (with immunosuppressant medications: basiliximab, tacrolimus, mycophenolate mofetil, prednisolone), cinacalcet (halted on day 26 after transplantation), angiotensinconverting-enzyme inhibitor, angiotensin-receptor blocker, hydrochlorothiazide, emergency dialysis, subtotal parathyroidectomy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Cinacalcet
  • Graft Survival / drug effects
  • Humans
  • Hyperparathyroidism, Secondary / drug therapy*
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Naphthalenes / adverse effects*
  • Nephrocalcinosis / chemically induced*
  • Postoperative Complications / drug therapy
  • Transplantation, Homologous


  • Naphthalenes
  • Cinacalcet