Alkalosis

Scientists at Columbia University report research in kidney research

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"Past medical history was notable solely for tobacco use (two packs per day for 20 years). There was no history of hypertension or diabetes and there was no family history of renal disease. The patient took no prescription medications but reported taking antacids as needed and occasional ibuprofen. Physical examination revealed a heart rate of 92 b.p.m., respiratory rate of 12 breaths per min, blood pressure of 108/62 mmHg, and the absence of edema or cutaneous manifestations. Laboratory evaluation (Table 1) revealed acute kidney injury with a creatinine of 7.2 mg/dl, mild hypokalemia, hypercalcemia, mild hyperphosphatemia, a severe non-anion gap metabolic alkalosis, and a suppressed parathyroid hormone level. The patient reported having not seen a physician for 10 years, and no baseline laboratory values were available for comparison. Urinalysis revealed trace protein and a bland sediment with no red blood cells, white blood cells, or casts. The patient was found to have a urine protein-to-creatinine ratio of 0.37 (mg/mg). Serologic evaluation revealed normal C3 and C4 complement levels and no evidence of a monoclonal spike on serum or urine protein electrophoresis. The following serologies were negative: antinuclear antibody, antineutrophil cytoplasmic antibody, antistreptolysin O, antiglomerular basement membrane antibody, hepatitis B surface antigen, and antihepatitis C antibody. The kidneys measured 9 cm in length by ultrasound, with increased echogenicity but no evidence of obstruction. Two discreet areas of dystrophic calcification were noted within the interpolar region of the renal parenchyma and measured 6 and 3 mm. The patient was admitted and given intravenous normal saline with added potassium for treatment of hypercalcemia and hypokalemia, antiemetics, and a proton pump inhibitor. Over the course of 4 days, the patient's creatinine declined to 4 mg/dl and serum calcium and potassium levels normalized. The patient was discharged. Following discharge, the patient was feeling well and the creatinine declined over 2 weeks to 2.3 mg/dl. Five weeks later, the creatinine was 1.6 mg/dl. Two months after the initial presentation, repeat serum chemistries again revealed acute kidney injury with a creatinine of 5.4 mg/dl. At that time, the patient had a serum sodium of 134 mmol/l, potassium 2.9 mmol/l, chloride 75 mmol/l, CO2 44 mmol/l, calcium 12.8 mg/dl, and phosphorus 6.7 mg/dl. The patient reported no significant new symptoms although he did mention persistent 'heartburn'," wrote L.C. Herlitz and colleagues, Columbia University.

The researchers concluded: "On his own, he had discontinued taking the proton pump inhibitor and restarted antacids, without relief of symptoms. Similarly, he'."

Herlitz and colleagues published their study in Kidney International (A case of nephrocalcinosis. Kidney International, 2009;75(8):856-859).

For additional information, contact G.S. Markowitz, Columbia University, Dept. of Pathology, College Physics & Surgery, 630 W 168th St., VC14-224, New York City, NY 10032, USA.

The publisher's contact information for the journal Kidney International is: Nature Publishing Group, 75 Varick St., 9TH Flr, New York, NY 10013-1917, USA.

Keywords: United States, New York, Life Sciences, Renal Disease, Diabetes, Nephrocalcinosis, Endocrinology, Hypercalcemia, Hypertension, Nephrology, Hypokalemia, Alkalosis, Hematuria, Vomiting, Nausea, Edema, Hormones, Ibuprofen, Pharmaceuticals, Drugs, Therapy, Treatment, Kidney, Blood Pressure, Columbia University.

This article was prepared by Physician Law Weekly editors from staff and other reports. Copyright 2009, Physician Law Weekly via NewsRx.com.