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Hypocalcaemia often occurs in patients after parathyroidectomy (PTX) due to hypoparathyroidism and/or hungry bone syndrome. To avoid hypocalcaemia, patients are substituted with large doses of calcium and vitamin D. Here, we present four patients, who developed acute renal faliure with hypercalcaemia and/or histologically confirmed nephrocalcinosis after PTX due to oversubstitution with vitamin D analogues and calcium. As a consequence, serum and urinary calcium should be closely monitored after PTX, and calcium and vitamin D substitution should be continuously adapted to avoid not only hypocalcaemia but also nephrocacinosis and hypercalcaemic renal failure.