Few tips on Hypercalcemia of Malignancy.
1.Occurs in 20-30% of patients with cancer
2. Usually the cancer is evident 90% of the time before the calcium problem arises.
3. Highest risk is Renal Cell Cancer, followed by Non small cell lung, Myeloma and then leukemia and breast cancer
4. 3 main mechanisms:- replacement of normal bone structure by metastatic cells and destruction via IL-6, IL-1 and TNF-alph stimulating osteoclastic activity; pthRp production by the tumor leading to binding to pth receptors in kidney and bone and causing similar effects as pth would; 1,25 0h vitamin D production mainly by lymphomas leading to increased intestinal absorption.
5. pth production (ectopic) is rare but can be seen. Primary hyperparathyroidism can occur in cancer patients as well.
6. Vitamin D(25-0H) can be elevated if there is excessive Vitamin D intake.
7. IV fluids, furosemide, calcitonin are few initial drugs to be used. Dialysis might be needed in some serious cases.
8. Pamidronate is safe in patients with CKD and hypercalcemia. It does cause Collapsing glomerulopathy. Zolendronate is to be used with caution in CKD as it can cause ATN.
9. Based on ASO guidelines, patients with moderate CrCl 30-60ml/min require no dose adjustment for pamidronate but require it for zolendronate. For severe disease <30cc.min, zolendronate is contraindicated and pamidronate infusion time is increased to 4-6 hours and dose decreased.
Cancer and the Kidney, Eric Cohen, 2nd Edition.
- ► 2018 (55)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- Geriatric Nephrology
- TOPIC DISCUSSION: Ageusia and ACEI/ARBS
- Nephrology Quiz at UKidney.com
- Disorders of Sodium & Water Balance: A mathematic...
- IN THE NEWS- Idiopathic Membranous GN and HLA-DQA1...
- Skin cancer and Transplants
- TOPIC DISCUSSION: Is Veno-occlusive disease associ...
- JOURNAL CLUB: ESCAPE TRIAL
- Nephrology Anagrams
- TOPIC DISCUSSION: Renal Vein Pressures and Cardio ...
- World Kidney day
- CLINICAL CASE 33, ANSWER AND SUMMARY(IMAGE QUIZ)
- Suggest and Vote for New Ideas in Nephrology
- Risk factors for post transplant Hypertension
- TOPIC DISCUSSION: Pseudohyperphosphatemia
- TOPIC DISCUSSION: Hypercalcemia of Malignancy
- JOURNAL CLUB: BELATACEPT and Transplantation
- TOPIC DISCUSSION: Lactic acidosis and Dialysis?
- Male Fertility and Transplantation
- TOPIC DISCUSSION: Membranous and Class Type IgG
- Renal Blog in finalist for Best Medical Blog( Clin...
- TOPIC DISCUSSION: Spontaneous Perinephric Hemorrha...
- Nephsap review: Transplantation
- Acute Kidney Injury in Cancer Patients
- CLINICAL CASE 32, ANSWERS AND SUMMARY
- ▼ February (25)
- ► 2010 (461)