drk1980
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A hypertensive patient of yours has been on a diuretic for a number of years. On a recent KUB x-ray you notice diffuse Ca deposits. What is the likely diuretic?
1. Furosemide
2. Spironolactone
3. ACE inhibitor
4. Hydrochlorothiazide
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| msyamp
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furosemide or lasix
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| mjl1717
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Furosemide pts Ca near the urine.
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| ssrpk
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diffuse Ca++ deposits (not a stone), sugests hypercalcemic nephropathy!
d- hydrochlorthiazide is the answer!
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| Geroo
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4. Hydrochlorothiazide
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| robin082006
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agree with Geroo and ssrpk
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| msyamp
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oh so it is metastatic calcification? good one. veytricky.
thanks guys
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| drk1980
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tricky wasnt it?!
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| msyamp
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ya good one
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| mjl1717
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yes good q. I just blew that. Lasix is known for lowereing Ca./ HCTZ would cause hypercalcemic nephropathy
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| DrPak
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Could someone give the pathogenesis of this? How does the thiazide do this? Is is because the reabsorbed Ca accumilates in the renal tubular cells? Is this an idiosyncratic reaction?
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| drk1980
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it is the same ADE of thiazide u hv already studied abt. Increased Ca+ reabsorption at the DCT. therefore excessively elevated plasma levels of Ca+ which finally lends it to deposit itself in body tissues.....an example of metastatic calcification. In teh Q u see it on a KUB xray.......tht kinda trips u into thinking the calcium is in the renal tract, but actually they are diffuse deposits of the same.
anyone wud like to add more plz?
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| msyamp
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if DRK says nothing more required hahaha
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| DrPak
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In the KUB Xray, you said there were diffuse calcifications. I think if they were metastatic, the Xray would clearly show calcifications outside the kidney and there wouldn't be the temptation of thinking it was furosemide induced hypercalciuria. On the other hand, if the calcifications were limited to the kidney, it would be hypercalciuria causing kidney stones.
The KUB is the key here. Are the calcifications limited to the kidney or not? That's key to the diagnosis.
Great question though. Keep them coming.
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| drk1980
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IMO the mention of KUB might hv two ideas: Either to throw u off into thinking ur looking at renal calcium stones(ADE lasix) OR the fact tht the calcium reabsorption is happening in the kidney and so naturally the high Ca plasma levels are encountered first by kidney tissues.....tubular membranes etc and so the place of maximum deposition.
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| DrPak
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If the X-ray is described in words as a KUB Xray, it implies an emphasis on the renal system and one would assume that the 'calcium deposits' in question are also assumed to be there.
However, now I'm begining to think the word 'diffuse' was clue enough that the cases wasn't hypercalciuria. If there were calcium deposited all over the tubular collecting system, they would simply be washed away in the urine because they'd be very small. A more likely manifestation of hypercalciuria would be renal stones, not diffuse calcifications.
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| drk1980
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u got it! diffuse is the key word. However plz note tht KUB is just a view of an Xray. Its purpose is not restricted to checking renal system.....one may generally do a KUB view to rule out differentials....
also wanted to clear up that the ca deposits u mentioned in the tubular collecting system wud be iinside the cells and static and wudnt get 'washed away in urine'.
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