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Submitted: 13 Oct 2018
Accepted: 03 Feb 2019
First published online: 18 Feb 2019
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J Nephropharmacol. 2019;8(2): e15.
doi: 10.15171/npj.2019.15
  Abstract View: 262
  PDF Download: 292

Case Report

Pseudohypercalcemia in a patient with multiple myeloma and acute kidney injury; a case report

Mohammad Khaledi 1, Rezvan Salehidoost 1, Mohammadreza Khosravifarsani 2 ORCID logo, Ashraf Aminorroaya 1 *

1 Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Cancer Prevention Research Center, Isfahan University of medical sciences, Isfahan, Iran
*Corresponding author: Ashraf Aminorroaya, Email address: Email: aminorroaya@med.mui.ac.ir

Abstract

Here in this paper, we present a 60-year-old man admitted for generalized pain in his limbs and was finally diagnosed with multiple myeloma. He also underwent evaluation and treatments for his hypercalcemia (15 mg/dL). His calcium concentration did not respond well to different modalities and was along with a low parathyroid hormone (PTH) and elevated creatinine concentration (12 mg/dL). Further evaluations revealed normal ionized calcium which confirmed the diagnosis of pseudohypercalcemia. Multiple myeloma is a plasma cell neoplasm in which 10% of the patients suffer from true-hypercalcemia at the time of diagnosis. Pseudohypercalcemia is described as an elevated serum calcium concentration along with normal ionized calcium concentration and the absence of clinical symptoms of hypercalcemia. The cause of pseudohypercalcemia in multiple myeloma is due to the binding of calcium to increased abnormal immunoglobulins. The importance of this issue lies in the low PTH levels along with hypercalcemia and azotemia which is suggestive of pseudohypercalcemia.
Keywords: Pseudohypercalcemia, Multiple myeloma, Plasma cell neoplasm, Hypercalcemia, Glomerular filtration rate, Acute kidney injury

Implication for health policy/practice/research/medical education:

Physicians must be careful and aware of pseudohypercalcemia in patients with multiple myeloma who have low PTH level despite renal failure. In such situations, ionized calcium concentration is suggested to be measured at the first step to prevent unnecessary treatments.

Please cite this paper as: Khaledi M, Salehidoost R Khosravifarsani M, Aminorroaya A. Pseudohypercalcemia in a patient with multiple myeloma and acute kidney injury; a case report. J Nephropharmacol. 2019;8(2):e15. DOI: 10.15171/npj.2019.15

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