Sixty-four of 68 subjects with initial renal sonograms were reassessed during follow-up and the ratio of nephrocalcinosis
and/or nephrolithiasis was found to have decreased to 28.1% (n=18) after a follow-up duration of 1[+ or -]0.9 years.
Longstanding hypercalcemia may lead to nephrocalcinosis
and nephrolithiasis and, less frequently, tubular necrosis, tubulointerstitial nongranulomatous inflammation, and renal failure.
Hypercalcemia results in hypercalciuria and sometimes nephrocalcinosis
, especially in the infantile form (8).
One of the mechanisms that have been proposed for kidney injury in these cases is the excess use of vitamin D, leading to hypercalcemia, hypercalciuria and nephrocalcinosis
Nephrolithiasis is responsible for 2 to 3% of end-stage renal cases if it is associated with nephrocalcinosis
Patient Age at transplant Gender Race (years) 1 37 Female White 2 33 Female White 3 40 Male White 4 58 Male White 5 50 Male White 6 44 Male Asian 7 21 Female White Patient Cause of ESRD Donor type 1 Nephrocalcinosis
Living related 2 Dysplastic kidney disease Living related 3 Focal segmental glomerulosclerosis Living related 4 Obstructive uropathy/chemotherapy Living related 5 Lithium toxicity Living unrelated 6 IgA nephropathy Deceased donor 7 Unknown Living related Patient Induction 1 Thymoglobulin 2 Thymoglobulin 3 Unknown 4 Thymoglobulin 5 Thymoglobulin 6 Thymoglobulin 7 Unknown TABLE 2: Time between transplant and biopsy, biopsy and conversion, and transplant and conversion.
Bartter syndrome is a hereditary salt-losing renal tubular disorder characterized by hypokalemic metabolic alkalosis, hypercalciuria, nephrocalcinosis
, polyuria, and hyperreninemia with normal arterial blood pressure.
Florid bilateral nephrocalcinosis
was present, consistent with longstanding hypercalcemia.
There are many causes of distal RTA, which causes may be primary or (more commonly) secondary (due to paraproteinemia, medullary sponge kidney, nephrocalcinosis
, obstructive uropathy, or autoimmune disease, etc.) (4) In our patient, the history of subjective xerophthalmia, subjective xerostomia, and positive anti-SS-A (Ro) and anti-SS-B(La) along with the results of the 5-minute Schirmer's test together supported the clinical diagnosis of pSS (5).
In the follow-up, direct hyperbilirubinemia and nephrocalcinosis
dTRA is a disease characterised by an unbalanced pH in the body associated with additional disorders such as biochemical impairments that may result in failure to thrive, rickets/osteomalacia, lithiasis and nephrocalcinosis
that can lead to renal failure.
Renal ultrasound revealed bilateral nephrocalcinosis
. The rest of the laboratory tests were within the normal range (e.g., serum creatinine, liver function tests, thyroid function tests, enzyme-linked immunosorbent assay for human immunodeficiency virus, hepatitis B surface antigen, and anti-hepatitis C virus).
Table 1 Signs of vitamin D toxicity Signs of vitamin D toxicity Headache Metallic taste Nephrocalcinosis
or vascular calcinosis Pancreatitis Nausea Vomiting
The predominant underlying disease among the analyzed patients was glomerulonephritis (32%), arterial hypertension (27%), polycystic kidney (11%), diabetes mellitus (8%), other (diabetes mellitus/arterial hypertension, undetermined, lupus, urinary tract infection, nephritis, nephrocalcinosis
, nephrolithiasis, vesicourethral reflux) with 22%.