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Nephrocalcinosis 
Soepel: 4 
Abdul waris khan 
Dept: internal medicine
SOEPEL 
• Subjective: a 44 years old male married working in a factory 
presented to ER with complains of haematuria, poly...
• Objective: History taking appropriate to the symptoms and physical 
examination. 
• Evaluation: UTI, DM, hypercalcemia, ...
Definition 
• Nephrocalcinosis is a condition in which calcium levels in the 
kidneys are increased.
• Hypercalcemia is also a well-established cause of renal failure, through 
direct renal vasoconstriction and volume deple...
• Microscopic nephrocalcinosis:- 
o microscopic crystalline calcium precipitates in the form of oxalate or phosphate. 
• M...
Pathophysiology 
Calcium is a cation that is transported, 
along with sodium, potassium, and 
water, in a complex and regu...
Clinical presentation 
• Calcium nodules may rupture through the papillary epithelium into the 
calyceal system to become ...
• The following may be noted: 
 Polyuria and polydipsia may be prominent because of the excess of free water diuresis wit...
Workup 
 Measurement of serum calcium, phosphate, and albumin levels is 
necessary to establish whether nephrocalcinosis ...
 The serum potassium concentration may be low when 
nephrocalcinosis is caused by certain conditions, such as distal rena...
Management 
 Adequate hydration with an isotonic sodium chloride solution is the 
single most effective measure for rever...
 Thiazide diuretics and dietary salt restriction will reduce renal calcium 
excretion e,g Hydrochlorothiazide. The usual ...
References 
• Emedicine.medscape.com 
• Kumar and clark 7th edition
Nephrocalcinosis
Nephrocalcinosis
Nephrocalcinosis
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Nephrocalcinosis

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Nephrocalcinosis

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Nephrocalcinosis

  1. 1. Nephrocalcinosis Soepel: 4 Abdul waris khan Dept: internal medicine
  2. 2. SOEPEL • Subjective: a 44 years old male married working in a factory presented to ER with complains of haematuria, polyuria and polydipsia. • H/O presenting illness: the symptoms have been there for past 8 days and are progressing. The blood in the urine is mixed. He is known to be hypertensive for a year. • No past medical history • No family history
  3. 3. • Objective: History taking appropriate to the symptoms and physical examination. • Evaluation: UTI, DM, hypercalcemia, nephrocalcinosis • Plan: CBC, U&E, CT, X-ray, urine culture • Elaboration: Appropriate management according to the diagnosis.
  4. 4. Definition • Nephrocalcinosis is a condition in which calcium levels in the kidneys are increased.
  5. 5. • Hypercalcemia is also a well-established cause of renal failure, through direct renal vasoconstriction and volume depletion induced by excessive diuresis.
  6. 6. • Microscopic nephrocalcinosis:- o microscopic crystalline calcium precipitates in the form of oxalate or phosphate. • Macroscopic nephrocalcinosis:- o observed on visual or radiologic examination without further magnification.
  7. 7. Pathophysiology Calcium is a cation that is transported, along with sodium, potassium, and water, in a complex and regulated manner along the renal tubular epithelium. Increased extracellular calcium leads to impairment of the calcium messenger system with gross tubular impairment. Hypercalcemia results in renal vasoconstriction and a reduced GFR. It also interferes with renal tubular functions. Impaired renal concentration ability and resistance to vasopressin are the most common defects observed with hypercalcemia.
  8. 8. Clinical presentation • Calcium nodules may rupture through the papillary epithelium into the calyceal system to become urinary stones and elicit the clinical presentations of:  Renal colic  Hematuria  Passage of urinary stones  Urinary tract infection
  9. 9. • The following may be noted:  Polyuria and polydipsia may be prominent because of the excess of free water diuresis with reduced renal concentrating ability.  Microscopic pyuria is common and represents a chronic inflammatory response to medullary calcification.  Distal tubular dysfunction is common with a mild salt-losing defect; it may become obvious only with profound decrease of oral intake (anorexia) or when another source of salt-water loss (eg, diarrhea or vomiting) emerges.  Medullary nephrocalcinosis of any etiology can cause secondary distal tubular acidosis related to distal tubular calcium deposition and chronic inflammation in the medulla.  Patients may present with renal failure or with features of their underlying disease
  10. 10. Workup  Measurement of serum calcium, phosphate, and albumin levels is necessary to establish whether nephrocalcinosis is associated with hypercalcemia.  The serum phosphate level is low in primary hyperparathyroidism with normal renal function, however, it is typically elevated in nephrocalcinosis associated with renal insufficiency.  Blood urea nitrogen (BUN) and serum creatinine levels are elevated when nephrocalcinosis is associated with renal insufficiency.
  11. 11.  The serum potassium concentration may be low when nephrocalcinosis is caused by certain conditions, such as distal renal tubular acidosis (RTA)  Urinalysis and urine culture should always be performed to look for evidence of chronic infection. Elevated urinary pH may suggest distal RTA  Assessment of 24-hour urinary excretion of calcium, oxalate, citrate, and uric acid, with simultaneous determination of BUN, creatinine, and protein excretion, can be very helpful in calculating measured renal function.
  12. 12. Management  Adequate hydration with an isotonic sodium chloride solution is the single most effective measure for reversing hypercalcemia and protecting the kidneys.  Calcium-sensing receptor stimulant cinacalcet (for correction of hyperparathyroidism)  Steroids (to decrease intestinal calcium absorption and vitamin-D activity)  Calcitonin or bisphosphonates (to inhibit bone resorption)
  13. 13.  Thiazide diuretics and dietary salt restriction will reduce renal calcium excretion e,g Hydrochlorothiazide. The usual dose range is 12.5-25 mg/day  Potassium and magnesium supplementation will increase the solubility of urinary calcium.  Citrate supplementation (preferably as potassium citrate) can be used in idiopathic hypercalciuria and in distal RTA because it increases urinary citrate and decreases urinary calcium excretion.
  14. 14. References • Emedicine.medscape.com • Kumar and clark 7th edition

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