Recurrent Nephrolithiasis Leading to Renal Failure: A Neglected Primary Hyperparathyroidism

Abstract

Introduction: Nephrolithiasis occurs in 7% to 40% of patients with primary hyperparathyroidism (PHPT). Approximately 5% of patients with nephrolithiasis will have hyperparathyroidism. This study presents a rare case of hypercalcemia secondary to PHPT, which eventually led to renal failure Case Presentation: This report presents a 55-year-old male presented with history of multiple kidney stones from 6 years ago, who had undergone multiple interventions by extracorporeal shock wave lithotripsy (ESWL). The result of lab exams were: BUN: 48 mg/dL, Cr: 2.83 mg/dL, calcium: 15.8 mg/dL, phosphorus: 4.4, serum intact parathyroid hormone (iPTH) = 1046pg/mL. At T99scan MIBI, the nuclear showed parathyroid adenoma in the inferior pole of the right thyroid. The patient underwent parathyroidectomy. Serum calcium level returned to normal range within 3 days after surgery. Conclusions: More attention must be paid to patients with recurrent nephrolithiasis, and such patients must be evaluated for PHPT before progressing to CKD.