RESUMEN
This report describes a novel presentation of chloride resistant metabolic alkalosis in a patient with hypercalcemia related to Multiple Myeloma (MM). A 51-year-old male with newly diagnosed MM presented with widespread skeletal involvement, calcium (Ca(+2)) of 18 mg/dL, phosphorous (PO4) of 6 mg/dL, serum bicarbonate (HCO3) of 37 mEq/L, and serum creatinine (Cr) of 2.6 mg/dL Other causes of metabolic alkalosis such as vomiting, diuretics, alkali ingestion, mineralocorticoid excess and hypokalemia were excluded. Hypercalcemia and metabolic alkalosis were only partially corrected after rehydration, calcitonin and steroids. Subsequent treatment with zoledronic acid resulted in resolution of hypercalcemia and correction of metabolic alkalosis.The chloride resistant component of metabolic alkalosis was most likely related to extensive release of Ca(+2), carbonate and phosphate from bone by activated osteoclasts with inhibited osteoblastic activity. The additional reduction in glomerular filtration rate due to MM, contributed to a triad mimicking Calcium-Alkali syndrome.
Asunto(s)
Alcalosis/etiología , Hipercalcemia/etiología , Mieloma Múltiple/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Cloruro de Sodio/uso terapéutico , Insuficiencia del TratamientoRESUMEN
Human immunodeficiency virus (HIV) infection can cause a broad spectrum of clinical manifestations, ranging from an asymptomatic carrier state to severe immunodeficiency. The most common renal lesion, HIV-associated nephropathy (HIVAN), is a sclerosing glomerulopathy. However, potentially reversible causes of renal disease in HIV-infected patients should also be considered. We describe two cases of patients with acquired immune-deficiency syndrome (AIDS) who presented with rapidly progressive renal failure but were found to have reversible etiologies. The first case was found to have syphilis and the second, disseminated histoplasmosis; their renal injury resolved after initiation of a third-generation cephalosporin antibiotic and amphotericin B, respectively.
Asunto(s)
Nefropatía Asociada a SIDA/etiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Histoplasmosis/complicaciones , Neurosífilis/complicaciones , Nefropatía Asociada a SIDA/patología , Adulto , Anfotericina B/uso terapéutico , Biopsia , Ceftriaxona/uso terapéutico , Histoplasmosis/tratamiento farmacológico , Humanos , Riñón/patología , Masculino , Neurosífilis/tratamiento farmacológicoRESUMEN
BACKGROUND: The National Kidney Foundation recommends reporting estimates of glomerular filtration rate (eGFR) rather than timed urine collections. When 2 of the 3 major hospitals in our region began reporting eGFR at different times we recognized a natural experiment. METHODS: We conducted a retrospective, observational study at the 3 major hospitals in Chattanooga, Tennessee. Data were collected on the frequency of timed urines during a 41/2-year period. Regression analysis was used to study the association of the rate of ordering timed urines adjusted for other factors. RESULTS: There was a marked drop in the rate of ordering of timed urines at all 3 hospitals from a mean of 21.8 per 1000 admissions in the first 4 quarter years of the study to 10.9 in the last 4 (15th-18th) quarter years. The drop began before the reporting of eGFR at any hospital. The reporting of eGFR had a small effect (-1.7 per 1000 hospital admissions) that was not statistically significant (P = 0.15). CONCLUSIONS: There has been a marked drop in the ordering of timed urines in our region. The decline began before the reporting of eGFR at 2 of the hospitals and therefore is attributable to other factors.