AKI and Hypercalcemia in a Patient with Weakness and Fatigue

A 59-year-old, Black patient presented to the emergency department for fatigue and weakness lasting for several weeks. Past medical history was significant for hypertension and migraine headaches. Physical exam was nonfocal, with normal breath sounds, no peripheral lymphadenopathy, no rash, and no edema. Laboratory findings included BUN of 40 mg/dl (7–20 mg/dl), creatinine of 4.16 mg/dl, (0.6–1.2 mg/dl), serum calcium of 12.4 mg/dl (8.5–10.5 mg/dl), eGFR of 15 ml/min per 1.73 m2 (>60 ml/min per 1.73 m2), parathyroid hormone <3 pg/ml (10–65 pg/ml), 1,25-dihydroxyvitamin D of 72 ng/ml (25–40 ng/ml), and angiotensin-converting enzyme of 112 U/L (8–53 U/L). Head computed tomography scan and chest x-ray were unremarkable. Serologic studies, including cerebral spinal fluid analysis, were negative for malignancy. The elevated angiotensin-converting enzyme and 1,25-dihydroxyvitamin D levels made sarcoid a strong possibility. A kidney …