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ABSTRACT Introduction: Hypercalcaemia requiring nephrologist care is relatively uncommon and represents a select subgroup of patients who are more severe and complex with metabolic derangements and renal failure. Aetiological profiling of hypercalcaemia is important in this regard for its appropriate management. Aim: The present study aimed to identify the aetiological profile of hypercalcaemia and assess treatment response in patients presenting to a tertiary care centre in South India. Materials and Methods: The current prospective observational study was conducted at St Johns Medical college hospital, Bangalore, Karnataka, India from January 2024 to September 2025, including 27 adult patients (>18 years) with persistent corrected calcium levels >10.5 mg/dL. Aetiology was determined using biochemical markers and imaging. Patients were followed for 30 days to assess treatment response and outcomes. Frequencies and standard deviations were calculated. Chisquare test was applied for categorical data analysis. Paired t-test was used to analyse treatment outcome. Results: The mean age was 53.8±14.4 years, with 55.6% females. The mean serum calcium at presentation was 12.98±1.74 mg/ dL. The most common aetiologies were malignancy (37.03%, n=10, primarily plasma cell dyscrasia at 25.92%), followed by primary hyperparathyroidism (parathyroid adenoma, 22.20%, n=6) and iatrogenic causes (22.20%, n=6). Other causes included sarcoidosis (11.10%, n=3) and infective (7.40%, n=2). Mean calcium decreased to 9.17±1.07 mg/dL after 30 days in 24 patients. Notably, 40.74% had pre-existing Chronic Kidney Disease (CKD), and 12 out of 16 patients developed Acute Kidney Injury (AKI) secondary to hypercalcaemia. Non-specific symptoms like nausea/vomiting (77.77%) and fatigue (66.66%) were prominent. The cumulative mortality rate was 11.11% (n=3). Conclusion: Malignancy, primary hyperparathyroidism, and iatrogenic causes are the predominant aetiologies of hypercalcaemia in this region. Non-specific symptoms should prompt early suspicion. Increased awareness of judicious vitamin D supplementation as well as periodic health check is crucial to mitigate iatrogenic hypercalcaemia