Severe Hypercalcemia Caused by Calcium-Alkali Syndrome after 15 Years of Postoperative Hypoparathyroidism in a Patient with Undiagnosed Hyperaldosteronism.

Introduction: The triad of hypercalcemia, metabolic alkalosis, and acute kidney injury associated with ingesting high doses of calcium and absorbable bases characterizes the calcium-alkali syndrome. Clinical Case. We report the case of a patient with postthyroidectomy hypoparathyroidism 15 years ago due to differentiated thyroid cancer who presented with severe hypercalcemia. He had adequate control of calcemia for many years on treatment with calcitriol and calcium carbonate and hypertension treated with amlodipine, losartan, and hydrochlorothiazide. After a period of loss to follow-up, he suddenly presents with severe hypercalcemia, metabolic alkalosis, and loss of renal function. Upon hydration and withdrawal of calcitriol and calcium replacements, hypercalcemia resolved. The etiological investigation identified no granulomatous or neoplastic diseases, but an aldosterone-producing adrenal incidentaloma was found. The cause of hypercalcemia in this patient was calcium-alkali syndrome due to calcium carbonate replacement potentiated by hydrochlorothiazide and primary aldosteronism. Six months after the hospitalization and suspension of calcium and vitamin D, the patient returned to hypocalcemia, reinforcing the diagnosis. Conclusion: Although seldom described, the calcium-alkali syndrome is an expected complication for individuals with postoperative hypoparathyroidism, as they require lifelong calcium and vitamin D supplementation. This case also shows the importance of hydrochlorothiazide use and primary aldosteronism as possible triggers of life-threatening hypercalcemia.

Perfil socioeconômico dos pacientes com doença renal crônica em diálise na região noroeste do Rio Grande do Sul / Socioeconomic profile of patients with chronic kidney disease on dialysis in the northwestern region of Rio Grande do Sul

O baixo nivel socioeconômico é um fator de risco para doenças crônicas e tem sido demonstrada uma relação inversa da renda com a incidência de Doença Renal Crônica (DRC). Além disso, vários estudos têm descrito associação de características étnicas com a maior prevalência da doença. Neste estudo, foram analisadas as características demográficas e socioeconômicas de pacientes com DRC em hemodiálise na Região Noroeste do Estado do Rio Grande do Sul. Métodos: Foram avaliados 260 pacientes em hemodiálise no ano de 2004. O instrumento empregado na coleta de dados foi o questionário utilizado pelo Instituto Brasileiro de Geografia e Estatística (IBGE) no censo demográfico 2000. Os dados obtidos foram comparados com a população da região. Adicionalmente, foram coletados dados referentes à doença, posse de plano de saúde e data de encaminhamento ao nefrologista. Avaliou-se o desfecho da mortalidade após dois anos da coleta inicial dos dados. Resultados: A prevalência em hemodiálise observada foi de 368 por milhão de população (pmp). Foram encontradas diferenças estatisticamente significativas entre os pacientes em hemodiálise e a população da região, com maior prevalência de pacientes do gênero masculino, faixas etárias mais elevadas, etnia não caucasóide, proveniência do meio urbano e estado civil casado. Em relação aos dados socioeconômicos, os pacientes em hemodiálise participantes do estudo têm significativamente menor escolaridade, menor renda familiar e menor nível de classificação econômica. A mortalidade em dois anos foi significativamente maior em pacientes com idade superior a 50 anos, com menor escolaridade e ausência de plano de saúde privado. Entre os pacientes das classes econômicas A e B, a mortalidade foi significativamente menor. Conclusão: Em relação à população da região, os pacientes em hemodiálise são mais idosos, mais frequentemente do gênero masculino e de etnia afrodescendente, com menor escolaridade e renda.

Low socioeconomic status is a risk factor for chronic diseases and has been demonstrated an inverse relationship of income to the incidence of Chronic Kidney Disease (CKD). In addition, several studies have described the association of ethnicity with the highest prevalence of the disease. In this study, we analyzed the demographic and socioeconomic characteristics of patients with CKD on hemodialysis in the northwest region of Rio Grande do Sul Methods: We studied 260 hemodialysis patients in 2004. The instrument used in data collection was the questionnaire used by the Brazilian Institute of Geography and Statistics (IBGE) in 2000 census. The data obtained were compared with the population of the region. Additionally, data were collected regarding the disease, possession of health insurance and date of referral to the nephrologist. We evaluated the outcome of mortality two years after the initial collection of data. Results: The prevalence observed in hemodialysis was 368 per million population (pmp). Statistically significant differences were found between hemodialysis patients and the population of the region, with higher prevalence of male patients, older age groups, non-Caucasian ethnicity, origin of the urban environment and being married. In relation to socioeconomic data, the hemodialysis patients in the study have significantly less education, lower family income and lower-economic classification. Mortality at two years was significantly higher in patients older than 50 years, with less education and no private health insurance. Among patients of lower socioeconomic classes A and B, the mortality was significantly lower. Conclusion: In relation to the region's population, hemodialysis patients are older, more often than males of African descent and ethnicity, with lower education and income.