OVERVIEW
OVERVIEW
Hypercalcemic nephropathy is defined as renal organic damage and functional changes caused by hypercalcemia (serum calcium >2.8 mmol/L). It is mainly characterized by tubulointerstitial lesions. Renal concentrative dysfunction is the most significant and earliest appearing functional abnormality in hypercalcemic nephropathy.
Whether medical insurance
Yes
Department
Nephrology
Clinical symptoms
Polyuria, nocturia, irritable thirst, dehydration, etc.
Harm
It can lead to a sharp rise in blood pressure and rapid deterioration of renal function.
Complications
Hypertension, renal insufficiency, uremia, etc.
Examination
Blood calcium test, urine routine, urine calcium test, renal function test, renal biopsy, parathyroid function, X-ray examination, etc.
Diagnosis
Hypercalcemia combined with polydipsia and polyuria, together with the indicators of renal function impairment can be initially diagnosed.
Treatment principle
Actively treat the primary disease, control hypercalcemia, and protect renal function.
Curability
Curability is related to the primary disease.
Dietary recommendations
Give low calcium diet.
Etiology
Etiology
Complications due to hyperparathyroidism, bone tumors, and lung cancer.
Symptoms and Diagnosis
Typical symptoms
1. General clinical manifestations are often related to the level of blood calcium. (1) Mild hypercalcemia: mostly asymptomatic or only fatigue, decreased neuromuscular stress, loss of appetite and thirst. (2) Chronic hypercalcemia: metastatic calcification occurs in blood vessels, joints, cartilage, cornea and other parts. (3) Hypercalcemia crisis: nausea, vomiting, dehydration, psychotic-like behavior and mental disorders may occur.2. Renal manifestations (1) Early manifestations: renal tubular dysfunction, hypogranuluria, hyponatremia, hypokalemia, and even uremia may occur. (2) Late manifestations: half of the patients may develop hypertension, azotemia, and finally uremia.3. ComorbiditiesHypercalcemia patients are often combined with pyelonephritis, pyelonephritis, hypertension, urinary stones, ocular changes, itchy skin and renal failure.
Diagnostic basis
1. history of hypercalcemia, clinical symptoms such as polydrinking and polyuria.2. routine urinalysis may be normal or have mild proteinuria, sometimes red blood cells, white blood cells and tubular pattern can be seen.3. blood and urine calcium measurement, there is an elevation of blood calcium and an increase in urinary calcium; those with renal dysfunction and elevated parathyroid hormone, the increase in urinary calcium is not obvious.4. renal tubular concentrative function is decreased.5. dark blue calcium can be seen in the renal cortex and (or) medulla deposits (HE staining), and black in vonKossa staining.
Treatment
Treatment guidelines
Actively treat the primary disease, correct hypercalcemia and protect renal function by expanding capacity, promoting urinary calcium excretion and inhibiting bone resorption.
Drug treatment
1. Diuretic furosemide can be injected intravenously, and can be used in large amount in case of emergency, and attention should be paid to replenish potassium and magnesium. 2. Glucocorticoid has certain efficacy in hypercalcemia caused by tumor, vitamin D intoxication, and nodular disease. Prednisone or hydrocortisone treatment, about a week to see the effect, avoid prolonged use, in order to prevent osteoporosis.3. Calcitonin has the effect of inhibiting osteolysis, increase renal calcium clearance calcium salt chelated into a soluble filtration complex, increase urinary calcium discharge.
Surgical treatment
Etiological treatment mainly, such as surgical removal of parathyroid adenoma or hyperplastic glandular tissue.
Other treatments
Severe cases can be treated with dialysis, using calcium-free dialysis solution, and attention to phosphorus supplementation during dialysis.
Prognosis
Actively treating the primary disease, the prognosis of mild cases is better, and the prognosis of severe cases is poor.
Nursing care
Daily care
1. Pay attention to rest, ensure sufficient sleep, avoid strenuous exercise. 2. Exercise appropriately to enhance physical fitness. 3. Take good psychological care and keep a good mood. 4. Follow doctor’s instructions, use medication reasonably, and have regular review.
Dietary management
Give low-calcium diet, daily diet amount not less than 3000ml, increase calcium discharge.