Hypercalcemia in association with acute renal failure and rhabdomyolysis. Case report and literature review

The syndrome of hypercalcemia during the course of acute renal failure (usually associated with rhabdomyolysis) occurs most commonly in young men with very severe renal failure. Although fewer than 90 such patients have been reported, the prevalence of hypercalcemia in patients with rhabdomyolysis-associated renal failure averages 30%. Hypercalcemia occurs most commonly in the diuretic phase and resolves spontaneously. The mean duration of hypercalcemia is 14 days. The pathogenesis of this syndrome has not been clearly defined. In the rare instances where it has been measured, intact PTH is suppressed. In contrast, both elevated and suppressed values of plasma 1,25-dihydroxyvitamin D have been reported. The release of calcium from ectopic calcification in damaged muscle tissue provides a potential explanation for this syndrome. Therapy for the hypercalcemia should generally be conservative given its self-limited nature.