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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of 1,25(OH)2 vitamin D3-induced hypercalcemia on the course of aminoglycoside nephrotoxicity in the rat was studied. Daily gentamicin, 100 mg/kg body weight, was administered subcutaneously concomitant with 1,25(OH)2 vitamin D3, 50 ng s.c. to male Sprague-Dawley rats. This group was compared to rats injected with gentamicin alone, 1,25(OH)2 vitamin D3 alone, and an ethanol vehicle as a control. Structural and functional parameters of acute renal failure were assessed following 4, 6 and 7 days of treatment. Severe morphologic evidence of tubular injury was documented on day 6 in the group injected with gentamicin and 1,25(OH)2 vitamin D3. Correlative functional and metabolic evidence of tubular cell deterioration occurred in this group on day 7 as represented by an elevated blood urea nitrogen (BUN), 198 +/- 14 mg/dl (p less than 0.001 compared to all other groups), a heightened mean renal cortical homogenate calcium, 1,028.3 +/- 304.8 nmol/mg protein (p less than 0.05 or better compared to all other groups), and significantly increased mean cortical mitochondrial calcium content, 796.3 +/- 116.5 nmol/mg protein (p less than 0.01 in relation to all other groups). Elevated total serum calcium to a level of 11.9 +/- 0.2 mg/dl (p less than 0.001 compared to control group) developed in the gentamicin/1,25(OH)2 vitamin D3 group on day 4, 2 days prior to pronounced structural damage, and continued to be elevated through day 7. No difference in serum phosphorus levels, however, developed between control and gentamicin-plus-vitamin-D-treated animals except on day 7 when severe renal failure developed in this group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Potentiation of aminoglycoside nephrotoxicity by vitamin-D-induced hypercalcemia. 338 67

A study of 75 myeloma patients diagnosed at the Kenyatta National Hospital, Nairobi, is presented. The male to female ratio was 1.7:1; the mean age +/- s.d. was 51.5 +/- 12.5 (range 16-80) years; the peak age incidence of 32% occurred in the sixth decade. A combination of: anaemia (81.3%), osteolytic lesions on X-ray skeletal survey (80%), bone pains (66.7%) and an ESR above 50mm/hr (77.3%) formed an important diagnostic tetrad. Other significant findings included: hypoalbuminaemia (76%), elevated leukocyte alkaline phosphatase (61.3%), uraemia (54.7%), upper respiratory tract infections (44%), elevated serum creatinine (34.7%), raised alkaline phosphatase (33.3%), pathological fractures (32%), hyperuricaemia (30.7%) and hypercalcaemia (29.3). The study confirms that the disease is not infrequent in indigenous Kenyan Africans as previous literature seemed to suggest. Poor prognosis was significantly (p less than 0.05) associated with hypoalbuminaemia, raised serum blood urea, hyperuricaemia and an elevated serum creatinine level.
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PMID:Pattern of multiple myeloma in Kenyans. 338 12

Hyaluronic acid concentrations were measured by a laser nephelometric assay in serum samples from 50 patients with advanced disseminated neoplasm and 50 healthy controls matched for age and sex. The identity of hyaluronic acid was confirmed by a combination of electrophoretic and enzymatic techniques. The mean serum hyaluronic acid concentration for the control group was 1.09 mg/l, with a range of 0-4 mg/l. The mean concentration for patients with neoplastic disease was 10.38 mg/l, with a range of 0-100 mg/l. Sixty two per cent of the patients with disseminated neoplasm had serum hyaluronic acid concentrations above the control range. There was no correlation between the increased concentration of hyaluronic acid and tumour type, serum bilirubin, serum alkaline phosphatase, or serum urea concentrations. There was a higher incidence of hypercalcaemia in patients with increased hyaluronic acid concentrations, but the correlation between hyaluronic acid and calcium concentrations was not significant. In view of the possible role of hyaluronic acid in cellular differentiation and morphogenesis the finding of increased hyaluronic acid concentrations in patients with advanced neoplastic disease may be of fundamental importance in cancer biology.
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PMID:Serum hyaluronic acid in patients with disseminated neoplasm. 361 92

In 93 children, end-stage renal disease was treated with the new dialytic methods of continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) over 5 years. Modality survival rates at 36 months with CAPD, CCPD, or both were 20%, 93%, and 87%, respectively. Use of CCPD as the primary dilaytic method increased during the study period. The peritonitis rate was one episode per 11.8 patient treatment months and was similar with both CAPD and CCPD. Gram-positive organisms were cultured in 34% of these episodes of peritonitis. Staphylococcus aureus peritonitis was associated with a recurrence rate of 40% and led to catheter replacement in 45% of the episodes. Peritoneal membrane failure necessitating switching to hemodialysis was related to peritonitis in three patients. Of the 74 peritoneal catheters that required replacement, 70% were infected. Serial serum levels of urea nitrogen, potassium, calcium, phosphorus, albumin, and alkaline phosphatase remained stable, whereas serum creatinine level rose slightly over time. Episodes of hyperkalemia, hypercalcemia, and hyperphosphatemia were observed at a frequency of one episode per 12.2, 4.6, and 2.5 treatment months, respectively. Blood transfusions were required in once per 1.5 and 3.3 treatment months in seven anephric patients and in 35 patients with their own kidneys, respectively (P = 0.05). In prepubertal patients who received CAPD or CCPD for greater than 1 year, little or no improvement in growth occurred in relationship to either chronologic or bone age.
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PMID:Five years' experience with continuous ambulatory or continuous cycling peritoneal dialysis in children. 365 81

A man with severe hypercalcemia (22 mg/dl) secondary to ingestion of a calcium carbonate antacid (Tums) was admitted with obtundation and hyperreflexia, which disappeared with treatment. Laboratory values, which were consistent with milk-alkali syndrome, included low-normal serum chloride (96 mEq/L), normal phosphorus of 2.7 mg/dl (phosphorus is usually normal to increased in this syndrome), increased blood urea nitrogen (39 mg/dl), and increased serum creatinine (2.4 mg/dl). A normal C-terminal parathormone level helped distinguish this patient from patients with severe hypercalcemia due to primary hyperthyroidism. The ECG revealed a widened rather than a shortened QT interval, as well as a J wave, a broadened T wave, and a U wave with this marked hypercalcemia, all of which reverted to normal with correction of the hypercalcemia.
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PMID:Milk-alkali syndrome with a serum calcium level of 22 mg/dl and J waves on the ECG. 368 51

The clinical value of measuring serum immunoreactive parathyroid hormone (iPTH) for the diagnosis of primary hyperparathyroidism is sometimes debated, and the clinical significance of an elevated postoperative serum iPTH level is unknown. Therefore we studied 141 consecutive patients with primary hyperparathyroidism before and after parathyroidectomy to determine the clinical value of measuring serum iPTH by a mid-region-specific radioimmunoassay. Eighty-eight percent of the patients with primary hyperparathyroidism had an absolute increase in the level of serum iPTH (greater than 40 microliter Eq/ml) before surgery, and the remaining patients had an inappropriately increased level of serum iPTH for the simultaneous serum calcium level. Preoperative serum iPTH level correlated positively with serum calcium level and parathyroid tumor size. Postoperative elevation of serum iPTH level was common (as high as 40%) and was associated with higher preoperative levels of blood urea nitrogen, serum creatinine, and alkaline phosphatase and larger tumors. An elevated postoperative serum iPTH level without hypercalcemia did not indicate a failed parathyroidectomy, whereas negative parathyroid exploration and postoperative hypercalcemia were the best predictors of persistent hyperparathyroidism. We conclude that preoperative serum iPTH measurement is a very sensitive diagnostic test for primary hyperparathyroidism, but postoperative serum iPTH measurement is not a good predictor for persistent or recurrent hyperparathyroidism.
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PMID:Parathyroid hormone: before and after parathyroidectomy. 378 59

In order to determine the prevalence of rhabdomyolysis-associated acute renal failure (RM-ARF) and assess the effect of oliguria on biochemical features in this condition, 127 cases of ARF seen over 18 months were reviewed. Eleven cases of RM-ARF were seen, a prevalence of 8.6% of all cases of ARF. There were ten males and one female (age range 15-72 years) with precipitating events being trauma in three, coma in two, infection in two and other causes in five. Ten had concurrent clinical or historical evidence of dehydration, two had mild hypokalemia, and one abused alcohol. Serum and urine myoglobin by radioimmunoassay were greater than 800 ng/l in all cases tested. False negative tests for urine myoglobin by o-tolidine reaction after (NH4)2SO4 extraction occurred in four cases. Despite attempted forced saline diuresis and urinary alkalinisation, seven became oliguric and required dialysis for 12-81 days. Initially (pre-dialysis) oliguric patients had significantly higher maximum serum levels of potassium, phosphate, and rate of rise of creatinine, significantly lower trough levels of calcium, and no significant difference in peak creatine phosphokinase or uric acid levels than non-oliguric patients. Two subjects developed recovery phase hypercalcemia, four required fasciotomy for compartment syndromes, three sustained permanent nerve damage, and three required limb amputation. Ten survived, with a mean creatinine clearance of 96 ml/min after nine to 30 months. RM-ARF is common, may be clinically occult and show false negative urine myoglobin tests. Hyperkalemia, hyperphosphatemia, and hypocalcemia are more common in oliguric than in non-oliguric RM-ARF, but both have a good prognosis with appropriate medical and surgical management.
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PMID:Rhabdomyolysis and acute renal failure. 386 39

Thirteen patients with hypercalcaemia due to carcinoma received inorganic phosphate, orally or intravenously, as palliative treatment for their high serum calcium levels. The serum calcium promptly fell in all patients fully treated, and there was a striking clinical improvement in most patients. The blood urea was usually unchanged or became nearer to normal, while the serum phosphate altered variably. Only two of the eight patients who were studied at necropsy had microscopical nephrocalcinosis; corneal calcification was evident in both before phosphate treatment was started.This oral inorganic phosphate (1 gramme thrice daily) is a safe and effective means of treating hypercalcaemia due to carcinoma. An intravenous infusion of 1 gramme over eight hours may sometimes be required initially for patients who are vomiting.
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PMID:Phosphate treatment of hypercalcaemia due to carcinoma. 417 70

Experience is reported of the hydrocortisone suppression test in 140 hypercalcaemic patients, comprising 98 new cases of hyperparathyroidism and 42 cases of non-parathyroid malignant disease. The diagnostic accuracy of the test was compared in 168 patients with that of discriminant analysis, the discriminant functions being derived from plasma inorganic phosphate, alkaline phosphatase, chloride, bicarbonate, and urea, and the erythrocyte sedimentation rate. The hydrocortisone test and discriminant analysis each achieved a diagnostic accuracy of about 93% in 148 patients with either non-parathyroid malignant disease or hyperparathyroidism without osteitis fibrosa. When both tests pointed to the same diagnosis, they were wrong in less than 1% of cases. The hydrocortisone test was not helpful in patients with osteitis fibrosa. Both tests can be performed in any hospital with reliable standard laboratory services. Used in combination they have a high predictive value in distinguishing hypercalcaemia of parathyroid origin from that due to non-parathyroid malignant disease and have not led to errors of clinical importance. They should continue to play a major role in the differential diagnosis of hypercalcaemia until a prompt and reliable service finally establishes parathyroid hormone assay as the definitive laboratory procedure.
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PMID:Hydrocortisone suppression test and discriminant analysis in differential diagnosis of hypercalcaemia. 610 29

Increased renal uptake of 99mTc methylene diphosphonate (MDP) was observed irregularly in rats after methotrexate, vincristine or gentamicin, administered separately. Cisplatin regularly induced a dose-related increased MDP uptake which correlated with the degree of tubular damage histologically. The augmented MDP renal uptake was not consistently accompanied by a decreased clearance of simultaneously injected I-131 Hippuran, particularly at lower drug dose levels. This observation agreed with previous evidence that the mechanisms of tubular transport of diphosphonates and organic acids like Hippuran are different. At higher dose levels, the augmented MDP uptake was accompanied by increased renal calcium, hypophosphatemia, elevated serum urea nitrogen and creatinine, and only occasional, mild hypercalcemia. The magnitude of the increased renal uptake of MDP observed could not be explained by alterations in iron metabolism or by dehydration. Drug-induced renal retention of MDP by a factor of 2 or more above normal appears to be a useful indicator of tubular damage when other parameters of renal function are sometimes normal.
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PMID:Experimental drug-induced changes in renal function and biodistribution of 99mTc-MDP. 622 84


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