Resolution of Hyperparathyroidism, Renal Osteodystrophy and Metastatic Calcification after Renal Homotransplantation

In 17 patients followed for an average of 18 months after renal homotransplantation, mean phosphate clearance was 18 ml per minute, tubular reabsorption of phosphate 60 per cent, and creatinine clearance 58 ml per minute. Calcium infusion tests performed in six were abnormal in all but one. Bone disease present in five patients improved or resolved in the post-transplant period. Hypercalcemia developed one and a half to six months after transplantation in nine patients, probably because of hyperparathyroidism present since operation but unmasked when phosphorus depletion was induced by aluminum hydroxide, with consequent increased hypercalcemia, hypercalciuria and negative calcium balance. In seven patients the hypercalcemia was mild and resolved when the antacid was changed to aluminum phosphate. One patient was given long-term phosphorus supplementation, and one required parathyroidectomy for control of hypercalcemia.