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Thursday, January 14, 2010

CONSULT ROUNDS


Yesterday we discussed a case of nephrocalcinosis
What is that and what are the main causes?
Nephrocalcinosis is a condition in which calcium levels in the kidneys are increased. Usually its associated with calcium phosphate stones and picked up usually on a AXR or CT scan.
We extensively discussed the different causes that could lead to the images of nephrocalcinosis
Briefly they are listed below:
Rule them out when you see Nephrocalcinosis
1. Primary Hyperparathyrodism ( most common cause)
2. Distal Renal Tubular Acidosis ( complete and incomplete) , this is because of hypercalcemia, hypercalciuria, metabolic acidosis, and reduced excretion of citrate in the presence of increased urinary pH. 
3. Granulomatous Diseases ( TB, Sarcoidosis, --> due to excessive conversion of 1,25 Vitamin D). So hypervitaminosis D can also lead to it and so can Milk Alkali Syndrome
4. Idiopathic hypercalciuria is the other kind or anything that can lead to increase calcium in the urine
5. Medullary Sponge Kidney
Other rare causes
Renal Papillary Necrosis from Analgesics
Severe Osteoporosis
Primary Hyperoxaluria
Dent's Disease
Parathyroid carcinoma
Barter's Syndrome
Liddle's Syndrome

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