الملخص
SUMMARY Hypercalcemia is a frequent condition in clinical practice and when the most frequent causes are excluded, etiological diagnosis can be challenging. A rare cause of PTH-independent hypercalcemia is described in the present case report. A male adult with a history of androgenic-anabolic steroids abuse, and injection of mineral oil and oily veterinary compound containing vitamins A, D and E into muscles for local hypertrophy presented with hypercalcemia, nephrocalcinosis, and end-stage renal disease. On physical examination, the presence of calcified subcutaneous nodules and calcification of musculature previously infused with oily substances drew attention. Laboratory tests confirmed hypercalcemia of 12.62 mg/L, low levels of PTH (10 pg/mL), hyperphosphatemia (6.0 mg/dL), 25(OH)D of 23.3 ng/mL, and elevated 1,25(OH)2D (138 pg/mL). Imaging exams showed diffuse calcification of muscle tissue, subcutaneous tissue, and organs such as the heart, lung, and kidneys. The patient was diagnosed with PTH-independent hypercalcemia secondary to foreign body reaction in areas of oil injection. The patient underwent treatment with hydrocortisone for 10 days, single dose zoledronic acid and hemodialysis. He evolved with serum calcium levels of 10.4 mg/dL and phosphorus of 7.1 mg/dL. In addition, sertraline and quetiapine were prescribed to control body dysmorphic disorder. The medical community should become aware of new causes of hypercalcemia as secondary to oil injection since this should become increasingly frequent due to the regularity with which such procedures have been performed.
الملخص
PURPOSE: Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. METHODS: 116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. RESULTS: In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. CONCLUSION: Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.
OBJETIVO: Com a ampla utilização dos exames ultrassonográficos na avaliação pré-natal, é frequente o diagnóstico da hidronefrose fetal. A definição de obstrução do trato urinário no periodo pós-natal necessita da confirmação de redução da função renal além da hidronefrose. Neste estudo, acompanhamos uma série de pacientes consecutivos com hidronefrose intra-útero que persistiu no periodo pós-natal. MÉTODOS: 116 recém-nascidos com hidronefrose pré-natal diagnosticada pela ultrassonografia foram submetidos a protocolo específico de avaliação e companhados pelo periodo de 06 anos. RESULTADOS: Em 46 (38,8%) dos 116 pacientes foi confirmado o diagnóstico de estenose da junção ureteropiélica (JUP). Conforme os resultados do protocolo aplicado a correção cirúrgica da estenose da JUP foi realizada em 19 pacientes. Das 26 crianças encaminhadas inicialmente para observação clínica, apenas 6 (23%) necessitaram cirurgia durante o seguimento ambulatorial. Na análise geral, o procedimento cirúrgico para correção da estenose da JUP foi indicado em 25 pacientes. Nas outras 20 crianças não houve necessidade da realização da cirurgia. CONCLUSÃO: a hidronefrose fetal requer cuidadosa avaliação pós-natal. A estenose da junção pielo-ureteral é a anomalia mais frequente como causa da hidronefrose, e sua correção cirúrgica tem indicações precisas. O protocolo aplicado foi útil em diferenciar pacientes que não necessitaram cirurgia para tratamento da estenose da JUP.
الموضوعات
Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pregnancy , Hydronephrosis/etiology , Ureteral Obstruction/complications , Hydronephrosis , Hydronephrosis/therapy , Hydronephrosis , Prospective Studies , Ultrasonography, Prenatal , Ureteral Obstruction , Ureteral Obstruction/surgery , Ureteral Obstruction , Urinary Tract/abnormalities , Urinary Tract , Urinary Tractالملخص
Acute tubular necrosis(ATN) is a major complication of kidney transplantation, so as of urologic and vascular surgeries. In transplantation, although organ oerfusion with proper solution are feasible and at least partially effective, new approaches remains needed to avoid lost of graft function due to ischemic insults, an by this way, chlorpromazine may play this hole. Sixteen male reats were evaluated by scintigraphy (dynamic renal scan with Tc-99m-MAG3), before and after surgically promote ischemia of left kidney. Animals were divided in 3 groups: Group A (control) without ischemic insult; Group B (ischemia without chlorpromazine) and Group C (ischemia with chlorpromazine). Group B demonstrated marked decreased of left renal function, compared with itself (right kidney; p<0,001) and compared with groups A and C (both p<0,001). No statistically observations was noted in group A, that makes sure of non-error source of surgical procedure lonely (p<0,05). Nevertheless mild decrease of left renal function was observed in some animals of group C, these appointments were not statistically significant (p<0,05). Further studies may prove, in the future, its usefulness in humans, specially concerning kidney transplantation.