Liquid Silicone Injections: An Infrequent Cause of CKD and Kidney Stones

Introduction: The use of body-modifying cosmetic injections have increased over the last decades. Here we present an infrequent case of severe kidney-related complications due to hypercalcemia arising years after silicone injections. Case Description: A 44-year-old man with stage 4 chronic kidney disease , hypertension and human immunodeficiency virus on antiretroviral therapy, was found to have acute kidney injury (AKI). The patient's creatinine rose to 3.72 mg/dL from baseline of 2.5 mg/dL. Serum calcium was elevated at 13.5 mg/dL and ionized calcium at 1.79 mmol/L. Parathyroid hormone was at 20 pg/mL, relatively suppressed for CKD4. CT of abdomen and pelvis showed bilateral kidney stones, some larger than 2 cm, and extensive subcutaneous calcifications in the bilateral flanks, proximal thighs and buttocks (Figure 1). The patient disclosed that he had multiple silicone injections in those areas in 2001. His AKI and hypercalcemia improved with intravenous fluid, denosumab, and calcitonin. 25-hydroxyvitamin D, QuantiFERON gold, serum free light chain ratio, and SPEP were unremarkable. 1,25-dihydroxyvitamin D was at the upper limit of normal at 69.2 pg/mL and PTH-r peptide was mildly elevated at 5.8 pmol/L. PET-CT whole body was negative for occult malignancy. Unfortunately, the patient did not follow-up for confirmatory tissue biopsy or to receive outpatient denosumab. Discussion: We present a rare case of advanced CKD and extensive nephrolithiasis in the setting of hypercalcemia due to likely silicone injection-induced granulomatosis. Cosmetic silicone injections are not approved by the U.S. Food and Drug Administration for any anatomic site, and have been associated with 0.2 to 1% risk of granuloma formation, typically associated with 1,25 vitamin D mediated hypercalcemia. Although tissue biopsy was not obtained, the work-up for other causes of hypercalcemia was negative. There is no effective treatment to date. If silicone cannot be removed, the treatment focuses on reduction of hypercalcemia and removal of kidney stones.Figure 1.CT scan abdomen and pelvis (A) showing kidney stones and axial view (B) showing extensive bilateral calcifications of the buttocks