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- Title
Denosumab in a pediatric kidney transplant recipient with late, resistant hypercalcemia secondary to Pneumocystis jirovecii pneumonia.
- Authors
Beale, Felicity; Gkiourtzis, Nikolaos; Koneru, Sahiti; O'Brien, Catherine; Lalayiannis, Alexander D.
- Abstract
Kidney transplant recipients (KTR) are at an increased risk of developing Pneumocystis jirovecii pneumonia (PCP), especially during the first year after transplantation. This is the first reported pediatric KTR, with chronic kidney disease (CKD) secondary to kidney dysplasia and vesicoureteral reflux, who developed refractory and symptomatic hypercalcemia 5 years after transplantation. The hypercalcemia was resistant to treatment with intravenous hyperhydration, furosemide, and a low-calcium diet. A respiratory tract infection due to PCP treated with trimethoprim-sulfamethoxazole did not improve calcium levels. Due to the hypercalcemic symptom burden for the patient, a single dose of subcutaneous denosumab was used to achieve sustained clinical and biochemical improvement, without any severe adverse events. This case highlights the potential use of denosumab as a treatment option in pediatric KTR with refractory hypercalcemia related to PCP. Further study of denosumab in young people with CKD or kidney transplants is needed before routine use can be recommended.
- Subjects
CHRONIC kidney failure complications; KIDNEY transplantation; PATIENTS; TRANSPLANTATION of organs, tissues, etc.; FUROSEMIDE; RESPIRATORY infections; HYPERCALCEMIA; MONOCLONAL antibodies; CALCIUM; PNEUMOCYSTIS pneumonia; CO-trimoxazole; DISEASE risk factors; DISEASE complications
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 8, p2355
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-024-06288-7