Title: Hypercalcemia and Acute Kidney Injury in Malignancy
Authors: Dr Sameena Hussainy, Dr Pradeep Shenoy
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.77
Abstract
Introduction: Acute kidney injury (AKI) refers to an abrupt decrease in kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes. It is associated with increased morbidity and mortality.
Case Presentation: A 37 year old male presented with progressive sswelling and recurrent ulceration over right side of neck and malaise with extreme fatigability. He also consumes gutka very frequently since 8 years. On examination he was found to have large ulcer over the right supraclavicular region along with generalised lymphadenopathy, and hepatosplenomegaly. He was found to have anaemia (Haemoglobin -11 g/dl) acute renal failure (Serum creatinine - 2.54 mg/dl) and hypercalcemia (Serum calcium-17.1 mg/dl) and Vitamin D deficiency (Vitamin D – 5.37 ng/ml). Urine examination and PTH was normal. Ultrasound showed bilateral normal sized kidneys. On further evaluation, Ultrasound guided FNAC of the right axillary lymph node was done which revealed metastatic deposits favouring poorly differentiated squamous cell carcinoma. He was found to have a lesion in the right lung from which CT guided Biopsy was taken and he was diagnosed to have Non small cell lung carcinoma. Following management of hypercalcemia and AKI patient’s renal function improved and was started upon chemotherapy for lung cancer.
Conclusion: Pulmonary carcinoma is the most common solid tumor to metastasize to the kidneys, followed by gastric and breast carcinomas. Although rare, few cases of Aacute renal failure resulting from metastatic solid tumor with widespread renal parenchymal infiltration have been reported in the literature. Hypercalcemia secondary to malignancy can also present with AKI. This is a case of Lung malignancy which presented with AKI secondary to hypercalcemia.
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