Kidney injury caused by the vitamin D analogue calcitriol for psoriasis

[Fred]

This snippet from Clinical and Experimental Dermatology may make you think again about the use of topical vitamin D3 analogue calcitriol.

Quote:

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A 55-year-old man with severe plaque psoriasis presented with a 2-week history of feeling generally unwell with lethargy and thirst. His symptoms had developed 6 weeks after commencement of the topical vitamin D3 analogue calcitriol. Investigations revealed hypercalcaemia and acute-on-chronic kidney injury, probably directly induced by systemic absorption of vitamin D3 following extensive topical use. Topical calcitriol had been started as a steroid-sparing agent to reduce the patient's liberal potent corticosteroid usage during anti-tumour necrosis factor-alfa therapy. Topical vitamin D analogues are commonly prescribed in dermatological and general practice, with hypercalcaemia being a rare but potentially serious adverse effect. This case serves to outline key factors that may predispose to hypercalcaemia, such as disease extent, quantity of drug applied, comorbidities and concurrent medications, and it highlights the importance of considering these factors when prescribing topical therapies.

Source: onlinelibrary.wiley.com

*Early view.

[Bill]

It emphasises the importance of medical oversight, Fred. Was the patient taking d3 in other forms? I try to keep my drug taking to a minimum.

[Fred]

It emphasises the importance of medical oversight, Fred. Was the patient taking d3 in other forms? I try to keep my drug taking to a minimum.

Sorry Bill, I don't know. That is all I have.

[Bill]

Out of interest Fred, a work colleague's mother had a flair of psoriasis, and it sounds as if she had a very similar reaction: A much greater surface area of application leading to excessive vitamin d absorption causing elevated blood calcium which precipitated kidney damage. So thanks heaps, Fred. It was nice to be able to offer a possible explanation backed up with a case report. I will let you know if I find out more.

Cheers,

Bill

[Fred]

Out of interest Fred, a work colleague's mother had a flair of psoriasis, and it sounds as if she had a very similar reaction: A much greater surface area of application leading to excessive vitamin d absorption causing elevated blood calcium which precipitated kidney damage. So thanks heaps, Fred. It was nice to be able to offer a possible explanation backed up with a case report. I will let you know if I find out more.

Cheers,

Bill

You're welcome Bill, it's good to know the information on Psoriasis Club is helping.

Yes please do keep us updated.

[D Foster]

Would it manifest as calcium based kidney stones?

[Bill]

I have read that it can, Dave. I think a pitfall like this emphasises the value of specialist care and appropriate monitoring.

[D Foster]

I have a lot of problems with kidney stones which started about the same time as the P, maybe it's connected.