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Suijkerbuijk, J., Litjens, E.J.R., Cornelis, T.
Locatie(s): Zaal 0.2/0.3
Categorie(ën): Parallelsessie
Introduction: History of patients presenting with acute kidney injury (AKI) should always include the use of potentially harmful drugs such as non-steroidals and proton pump inhibitors, as well as the recent administration of intravenous contrast. We present a case with an uncommon risk factor for AKI.
Case report: A previously healthy 55-year old woman was referred to our hospital because of AKI. History was unremarkable except for nausea and weight loss (3 kg) since 3 weeks. She used omeprazole prescribed by the family doctor, and denied the use of other medication. Physical examination revealed no abnormalities. Laboratory investigation showed: creatinine 367 μmol/l (normal range: 50-100 μmol/l), total calcium 3.97 mmol/l (2.10-2.55 mmol/l), albumin 45.7 g/l (32-47 g/l), and PTH < 0.5 pmol/l (1.3-6.8 pmol/l). Urinalysis showed no albuminuria, 11-20 erythrocytes/μl, no dysmorphic erythrocytes and mild leucocyturia. Ultrasound showed normal size of the kidneys, and the absence of kidney stones, mass or hydronephrosis. The treatment consisted of forced calciuresis with intravenous saline and loop diuretics in combination with the administration of pamidronate, which resulted in normalization of calcium levels and partial restoration of the kidney function.
In order to determine the cause of the hypercalcemia and renal insufficiency, history was taken again. Patient revealed she and her sons followed a macrobiotic diet and had been using vitamin D and calcium supplements since 6 months. Vitamin D levels were indeed confirmed to be very high in this patient: 25-OH-D3 1700 nmol/l (normal range: 23-130 nmol/l). She admitted to have purchased these supplements online, and had been taking the recommended dose of vitamin D 50.000 IE/day.
Results: 4 months after hospitalization showed a creatinin level of 147 nmol/l (MDRD 32 ml/min/1.73m2), and normal calcium and persistently elevated vitamin D levels (286 nmol/l).
Conclusion: This case illustrates the importance of taking a thorough history in patients presenting with AKI, including the use of vitamin supplements. Also, health care personnel and patients should be aware of the potentially deleterious side effects of self-care medication.