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

Sixty-two-year-old man was admitted to hospital for increased serum level of calcium (3.85 mmol/l) and incipient renal failure (urea 7.2 mmol/l, kreatinin 117 mumol/l). The reason of hypercalcaemia was intensive explored. Serum level of intact PTH was 383.6 pg/ml. We performed two-dimensional early and delayed (2 hours) scintigram after intravenous administration of 750 MBq 99mTc-sestamibi, i.e. double-phase technique. There was detected focus (diameter 20 mm) of increased sestamibi uptake with slow wash-out in distal part right thyroid lobe. Planar scintigraphy obtained after intravenous administration of 185 MBq 99mTc-pertechnetate detected focus of increased 99mTc-pertechnetate uptake in the same point too. Patient underwent right thyroid lobectomy. There was colloid nodular goiter. Under right thyroid lobe was detected spherical particle. This particle was ablated (diameter 20 mm, weight 4 gram). It was parathyroid adenoma. One month after ablation of parathyroid adenoma serum level of PTH was 23.1 pg/ml and serum level of calcium was 2.52 mmol/l. There was overlap of scintigraphy image of parathyroid adenoma under distal part of right thyroid lobe on 99mTc-sestamibi two-dimensional scintigram and scintigraphy image of hyperplastic node with increased activity in distal part of right thyroid lobe on 99mTc-pertechnetate two-dimensional scintigram.
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PMID:[Disagreement between findings of 99mTc-MIBI and 99mTc-pertechnetate scintigraphy scans in patients with primary hyperparathyroidism]. 1501 33

Despite advanced techniques of renal replacement therapy the overall mortality of patients with ARF is still high. The majority of patients with ARF requiring dialysis are those with nontraumatic ARF. In a retrospective study we compared the causes of nontraumatic ARF, the risk factors for the development of renal failure and the mortality rates in patients with and without diabetes mellitus who received dialysis therapy in the years 1991-2000. A total of 232 patients were included in the study, 34 (14.6%) of them with and 198 patients (85.4%) without diabetes. The predominant causes of nontraumatic ARF like congestive heart failure (26.4 vs. 13.6, p < 0.05) and hypotension/hypovolemia (20.6 vs. 7.6%, p < 0.05) occurred more frequently in diabetic patients. The prevalence of sepsis (8.8 vs. 10.1%, NS), malignancy/ hypercalcemia (5.8 vs. 11.6%, NS) and other causes of nontraumatic ARF were similar in both groups. The prevalence of hepato-renal syndrome (5.8 vs. 13.6%, p < 0.05) and acute kidney graft failure (2.9 vs. 15.1%, p < 0.05) was higher in the nondiabetic individuals. Patients with diabetes showed more often chronic predictors for the onset of ARF like pre-existing hypertension (93.6 vs. 51.0%, p < 0.05), congestive heart failure (44.1 vs. 14.6%, p < 0.005), pre-existing renal insufficiency (76.4 vs. 46.9%, p < 0.05) and ACE-inhibitor therapy (32.3 vs. 9.6%, p < 0.005). Additionally, the prevalence of multiple organ failure (MOF) as prognostic factor was significantly higher in the diabetic patients (47.0 vs. 21.7%, p < 0.05). The mean number of dialyses therapy was 4.7 vs. 4.5 per patient. The overall mortality was 41.1 vs. 44.% (NS). In conclusion, the prevalence of the most common causes of nontraumatic ARF was different between the patients with and without diabetes. The diabetic individuals had more frequently predictors for the onset of ARF. The overall mortality was approximately the same in both groups.
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PMID:Causes and prognosis of nontraumatic acute renal failure requiring dialysis in adult patients with and without diabetes. 1508 20

In our preliminary experiment, we found that a constant infusion of a high dose of parathyroid hormone-related protein induced both hyperphosphataemia and hypocalcaemia, secondary to renal dysfunction. Therefore, in this study, we developed two types of parathyroid hormone-related protein-induced hypercalcaemia models. One is the hypercalcaemia model, which did not show renal-dysfunction-induced hypocalcaemia. This model might be suitable for estimating hypocalcaemic activities of drugs, especially of those that act on bone resorption. The other is the model for estimating histological changes, which is associated with renal dysfunction. We then used these models to investigate the effects of three different bisphosphonates. Since the hypercalcaemic effect of parathyroid hormone-related protein infusion plateaued at 20 pmol/h, and higher doses of parathyroid hormone-related protein caused an elevation of blood urea nitrogen, the parathyroid hormone-related protein infusion rate was fixed at 20 pmol/h to avoid renal dysfunction and at 40 pmol/h to elicit renal dysfunction. The hypocalcaemic efficiencies of clodronate and etidronate were almost the same but pamidronate was 17.9 times more potent than clodronate. Additionally, both clodronate and pamidronate decreased the plasma concentrations of blood urea nitrogen and the Ca2+ times inorganic P product, whereas etidronate lacked these effects. Clodronate suppressed renal calcification and tubular dilatation in the renal-dysfunction model. These data indicated that clodronate and pamidronate not only decrease the plasma Ca2+ concentration but also improve the renal dysfunction induced by hypercalcaemia.
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PMID:Rat model of the hypercalcaemia induced by parathyroid hormone-related protein: characteristics of three bisphosphonates. 1565 23

A review of records from the AnTox database of the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center identified 43 dogs that developed increased blood urea nitrogen concentration, serum creatinine concentration, or both as well as clinical signs after ingesting grapes, raisins, or both. Clinical findings, laboratory findings, histopathological findings, treatments performed, and outcome were evaluated. All dogs vomited, and lethargy, anorexia, and diarrhea were other common clinical signs. Decreased urine output, ataxia, or weakness were associated with a negative outcome. High calcium x phosphorus product (Ca x P), hyperphosphatemia, and hypercalcemia were present in 95%, 90%, and 62% of the dogs in which these variables were evaluated. Extremely high initial total calcium concentration, peak total calcium concentration, initial Ca x P, and peak Ca x P were negative prognostic indicators. Proximal renal tubular necrosis was the most consistent finding in dogs for which histopathology was evaluated. Fifty-three percent of the 43 dogs survived, with 15 of these 23 having a complete resolution of clinical signs and azotemia. Although the mechanism of renal injury from grapes and raisins remains unclear, the findings of this study contribute to an understanding of the clinical course of acute renal failure that can occur after ingestion of grapes or raisins in dogs.
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PMID:Acute renal failure in dogs after the ingestion of grapes or raisins: a retrospective evaluation of 43 dogs (1992-2002). 1623 10

Although uremia is well known as the most common cause of pruritus, the mechanisms of pruritus in chronic hemodialysis patients remain unclear. The purpose was to characterize uremic pruritus in more detail and to investigate whether severe pruritus is a marker for poor prognosis. A total of 1773 adult hemodialysis patients were studied. A questionnaire was given to each patient to assess the intensity and frequency, as well as pruritus-related sleep disturbance. We analyzed the relationship between clinical and laboratory data and the severity of pruritus in hemodialysis patients and followed them for 24 months prospectively. In total, 453 patients had severe pruritus with a visual analogue scale (VAS) score more than or equal to 7.0. Among them, more than 70% complained of sleep disturbance, whereas the majority of patients with a VAS score of less than 7.0 had no sleep disturbance. Male gender, high levels of blood urea nitrogen, beta2-microglobulin (beta2MG), hypercalcemia, and hyperphosphatemia were identified as independent risk factors for the development of severe pruritus, whereas a low level of calcium and intact-parathyroid hormone were associated with reduced risk. During the follow-up, 171 (9.64%) patients died. The prognosis of patients with severe pruritus was significantly worse than the others. Moreover, severe pruritus was independently associated with death even after adjusting for other clinical factors including diabetes mellitus, age, beta2MG, and albumin. Severe uremic pruritus caused by multiple factors, not only affects the quality of life but may also be associated with poor outcome in chronic hemodialysis patients.
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PMID:Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. 1667 24

Male rats exposed to 500 R of whole-body x-irradiation were allowed food and water ad libitum and housed in metabolism cages; water and food intake and urinary and fecal excretion were recorded daily. Urine output increased 200% during the first 24 hours after irradiation. No significant changes occurred in daily sodium, potassium, urea, or total solute excretion, although calcium excretion approximately doubled after irradiation. The marked increase in free water excretion implicates antidiuretic hormone (ADH) in this phenomenon. Application of a sensitive bioassay for ADH permitted measurement of plasma ADH concentrations in undisturbed, unanesthetized rats before and after irradiation. ADH levels were lower and frequently not detectable 24 hours after exposure. High ADH levels, however, could be provoked in irradiated rats by hemorrhage, indicating that the receptor cells and secretory ability of the posterior pituitary remained intact. Furthermore, irradiated rats responded normally to small intravenous injections (4 to 8 microU) of exogenous ADH. Rats with congenital diabetes insipidus given daily injections of Pitressin showed no postirradiation diuresis. Lastly, increased urinary calcium excretion may result from hypercalcemia which is known to induce diuresis through calcium-vasopressin antagonism. These results further suggest that the diuretic response is due to decreased circulating ADH.
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PMID:Circulating antidiuretic hormone in the X-irradiated rat. 1738 77

A 62 year old woman was referred to our hospital because of acute renal and liver dysfunction. Prior to admission, she had already been started on hemodyalysis filtration(HDF). She showed facial edema and lumbar pain caused by an Ll compressive fracture. Laboratory examinations revealed hypercalcemia (13.2 mg/dL), hyperammonemia (297 microg/dL) and her serum creatinine, blood urea nitrogen and total bilirubin levels were 3.9 mg/dL, 37.4 mg/dL and 3.2 mg/dL, respectively. Among the components of immunoglobulin, IgA was increased, while IgG and IgM were decreased. Serum immunoelectrophoresis revealed the presence of the IgA kappa type of M component. Punched out lesions were noted on her head radiography. Severe plasmacytosis (60-70 % of total cells) were observed by a bone marrow aspiration test, indicating the diagnosis of multiple myeloma. Steroid pulse therapy was started with dexamethasone (40 mg/day, 3 days), and plasma exchange was performed 8 times with continuous HDF. These treatments failed to control hemodynamics and she died of disseminated intravascular coagulation (DIC). Autopsy demonstrated amyloid-like depositions in perisinusoidal space in the liver. In the kidney, there were nodular lesions in the glomeruli, and depositions in the basement membrane of the uriniferous tubuli. Congo red staining of these organs for amyloid yielded negative results. Immunohistochemical staining gave positive results for IgA and kappa. Electron microscopy revealed granular electron deposits in the glomeruli and tubular basement membrane as well. Taken altogether, the diagnosis of the patient could be light chain deposition disease (LCDD).
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PMID:[A case of acute renal and liver dysfunction with light chain deposition disease]. 1757 93

The number of newly diagnosed cases of multiple myeloma in the Czech Republic is about 3-4 per 100 000 persons per year. In the higher age groups, the incidence increases. Multiple myeloma is an illness that reacts well to treatment which can result in periods of remission lasting for years. Some of the patients are even able to return to work. A pre-requisite for successful treatment is early diagnosis and this is usually in the hands of first line physicians. This is the reason why the Czech Myeloma Group, in conjunction with neurologists, orthopedicians and radio diagnosticians has issued the following recommendations for first line physicians containing a more detailed description of the symptoms and the diagnostic pitfalls of the disease. This disease reminds a chameleon for the variety of its symptoms. For the sake of clarification, we shall divide multiple myeloma symptoms into five points, each of which is reason enough to warrant an examination to confirm or rule out a malignant cause of health problems (a negative result does not automatically mean exclusion). If any of the recommended examinations results positive, the diagnostic process must be continued, in which case a general practitioner refers the patient to a specialist health centre. Observing these recommendations should minimize the number of cases of late diagnosis. 1. Bone destruction symptoms. - Unexplained backache for more than one month in any part of spine even without nerve root irritability or without pain in other part of skeleton (ribs, hips, or long bones). - Pain at the beginning of myeloma disease is very similar to benigne common discopathy, however the intensity of backache is decreasing within one months in benigne disease. In the case of malignant process the intensity of bone pain is steadily increasing. - Immediate imaging and laboratory investigation are indicated by resting and night pain in spinal column or in any part of skeleton. - Backache with the sign of spinal cord or nerve compression should be sent for immediate X Ray, and focussed CT/MRI followed by acute surgery if needed. - Osteoporosis especially in men and premenopausal women. 2. Features of changed immunity or bone marrow function. Persistent and recurrent infection, typical is normochromic anaemia, with leucopenia and trombocytopenia. 3. Raised erythrocyte sedimentation rate even increase concentration of total plasma protein. 4. Impaired renal function. Increased level of creatinin or proteinuria, nephrotic syndrome with bilateral legs oedema. 5. Hypercalcemia with typical clinical symptoms (polyuria with dehydratation, constipation, nausea, low level conscience, coma). Every one from these points has to be reason for general medical doctor to start battery of tests: -X-ray of bones focused to painful area (mandatory before physiotherapy, local anaesthesia or other empiric therapy). If plain X-ray does not elucidate pain and symptoms are lasting more than one month, please consider all circumstances and results from laboratory investigation. This patient needs referral to the centre with MRI/CT facilities (CT or MRI is necessary investigation in case of nerve root or spine compression). -Investigation of erythrocyte sedimantion rate (high level of sedimentation of erythrocyte can indicate multiple myeloma). -Full blood count. -Basic biochemical investigation serum and urine: serum urea, creatinin, ionts including calcium, total protein, and albumin CRP (high concentration of total protein indicates myeloma, low level of albumin indicates general pathological process, similary increased concentration of fibrinogen, impaired renal function indicates myeloma kidney, however hypercalcemia is typical for highly aggressive myeloma). -Quantitative screening for IgG, IgM and IgA in serum (isolated raised level one of immunoglobulin with decreased level of the others indicates myeloma). -Common electrophoresis of serum is able to detect monoclonal immunoglobulin level at few gramm concentration. If all the laboratory investigation are in normal level the possibility that the current problems are multiple myeloma origine is smaller, but it does not exclude one of rare variant--non secretory myeloma (undifferentiated plasmocyt lost characteristic feature to produce monoclonal immunoglobulin). If any of tests indicate the possibility of myeloma, patient require urgent specialist referral to department with possibility to make diagnosis of malignant myeloma.
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PMID:[Recommendations for early identification of damage to the skeleton by malignant processes, and for early diagnosis of multiple myeloma]. 1817 27

This case report describes the findings in a seven-month-old heifer with diabetes insipidus attributable to internal hydrocephalus. The heifer was referred to the clinic because of reduced appetite, polydipsia, decreased faecal output and weight loss. The heifer was examined daily for 8 days. She was thin and weak and had a dull dry hair coat and decreased appetite. The heifer urinated frequently; the urine was clear and yel low, had a specific gravity of 1.015. A complete blood cell count, biochemical profile and blood gas analysis revealed increased serum urea, increased serum creatinine, hypernatraemia, hyperchloraemia, hypercalcaemia and hypophosphataemia. The heifer received 10 litres of water and 3 litres of ruminal fluid from a healthy cow per os daily for 5 days. The heifer had access to fresh water ad libitum. The general condition of the heifer did not improve after this treatment. Although the concentration of serum urea and creatinine decreased, the concentrations of sodium, chloride and calcium remained higher than normal. Based on the findings, a diagnosis of diabetes insipidus was made and the heifer was euthanatized. Postmortem examination revealed severe internal hydrocephalus, and a definitive diagnosis of central diabetes insipidus attributable to internal hydrocephalus was made.
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PMID:[Diabetes insipidus in a Swiss Braunvieh heifer with internal hydrocephalus]. 1877 27

To determine the nutritional status of chronic hemodialysis (HD) patients and the association of changes in serum albumin levels, C-reactive protein (CRP), low density lipoprotein (LDL) cholesterol and body mass index (BMI) as indicators of nutritional status with the urea reduction ratio (URR) during dialysis, we studied 201 chronic HD patients (97 males and the mean age was 51 +/- 15 years). Diabetes was the cause of chronic kidney disease (CKD) in 34% of the patients, hypertension in 57%, chronic glomerulonephritis in 12%, and obstructive uropathy in 10%. BMI less than 18.5 (under weight) was found in 17% of patients, more 18.5 but less than 25 (normal) in 56%, more than 25 but less than 30 (overweight) in 21%, and more than 30 (obese) in 6%. The laboratory investigations revealed hypercalcemia in 62% of the patients (15 patients were found to have tertiary hyperparathyroidism), total cholesterol less than 100 mg/dL in 6% (mean 152 +/- 37.5 mg/dL), and URR of less than 60% in 12% of patients and greater than 60 but less than 65% in 33%. Hypoalbuminemia was associated with poor URR (P < 0.05), whereas no statistically significant correlation was found between URR and iPTH, LDL cholesterol, CRP and body mass index. We conclude that poor nutritional status was detected among a significant number of our patients with poor dietary education. Increased risk of malnutrition was significantly associated with older age and inadequate dialysis dose. Hypoalbuminemia was the single most important factor associated with poor URR.
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PMID:Biochemical nutritional parameters and their impact on hemodialysis efficiency. 1986 85


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