hypercalcaemia and acute uremia

Question 1

what is the normal albumin correctedd serum calcium level ?

Answer 1

8-10 mg/dl
equivalent to
2-2.5 mmol/l

Question 2

most common cause of hypercalcemia in hospitalized patients ?

Answer 2

malignancy

Question 3

how is the corrected calcium level calculated ?

Answer 3

0.8 x ( normal albumin level - patients albumin level ) + serum calcium level

Question 4

what is the normal albumin level ?

Answer 4

4 mg/dl

Question 5

3 main broad reasons for hypercalcemia ?

Answer 5

gastrointestinal absorption
renal tubular reabsorption of calcium
increased bone resorption

Question 6

what are the levels of hypercalcaemia ?

Answer 6

mild: 10-12 mg/dl
moderate: 12-14 mg/dl symptoms start from here
severe: more than 14 mg/dl

Question 7

clinical manifeestations of hypercalcaemia ?

Answer 7

stones : nephrolithiasis
bones : bone pain
groans : abdominal pain , myalgia , arthralgia
psychic overtones : confusion, anxiety, depression

Question 8

most common cause of hypercalcemia in patients with non metastatic solid tumors and NHL ?

Answer 8

tumor secretion of parathyroid hormone

Question 9

what are the other 2 mechanisms associated with hypercalcemia?

Answer 9

osteolytic metastasis with local release of cytokines
tumor production of 1,25-dihydroxyvitamin D (calcitriol)

Question 10

what is the other term used to refer to thee mechanism of parathyroid hormone release by tumors ?

Answer 10

humoral hypercalcemia of malignancy

Question 11

what are the typical lab findings in HHM ?

Answer 11

increased s.PTHrP
very low or suppressed serum intact PTH
normal to low serum 1,25-dihydroxyvitamin D

Question 12

what are the typical findings in patients with osteolytic metastases ?

Answer 12

low or suppressed PTH
Low or normal PTHrP
Low or normal serum 1,25 vit d

Question 13

what is the most common cause of hypercalcemia in lymphomas ?

Answer 13

1,25 dihydroxyvitamin D production
acting by increasing intestinal absorption of calcium

Question 14

patient presents with hypercalcemia and is given glucocorticoids and responds well to it - what was the most likely mechanism of hypercalcemia ?

Answer 14

1,25 dihydroxyvitamin D production

Question 15

what is the role of FGF23 in hypercalcaemia ?

Answer 15

FGF23 inhibits renal phosphate reabsorption
increasing the conservation of calcium

Question 16

what drugs are associated with hypercalcemia ?

Answer 16

lithium
calcium supp
thiazide and diuretics

Question 17

initial and first line of treatment of hypercalcemia ?

Answer 17

hydration with crystalloid IV fluid
patients with overall fluid overload - use a loop diuretic

Question 18

type of biphosphonate used to inhibit bone resorption ?

Answer 18

zoledronate

Question 19

what is thee management for hypercalcemia that is refractory to ZA ?

Answer 19

denosumab
or if the patient is allergic or has renal failure , denosumab can be used

Question 20

what is the second line treatment for hypercalcemia ?

Answer 20

calcitonin

Question 21

when should dialysis be considered ?

Answer 21

when hypercalcemia is accompanied by renal failure

Question 22

classification of urological obstruction?

Answer 22

low - obstruction at the level of the urethra prostate or bladder

high

Question 23

what are the symptoms associated with high UO vs low UO ?

Answer 23

high UO - presents with signs of uraemia
low UO - presents with signs of inability to urinate , or incontinence due to overflow of a full bladder

Question 24

what is the treatment for upper vs lower UO?

Answer 24

with high UO : if the cause is not reversible in the short term or if there is signs of severe renal failure - diveersion of the urinary tract is indicated

with Low UO : urinary foley catheter placement or a suprapubic tube if there is a tight urethral stricture

Question 25

how is a diagnosis of upper UO made ?

Answer 25

ultrasound first
followed by CT without contrast or MRI

Question 26

how is a diagnosis of Low UO made ?

Answer 26

suprapubic tenderness
ultrasound used to confirm the diagnosis if not clinically clear

Question 27

what are the two types of cystitis associated with cancer patients ?

Answer 27

radiation induced cystitis
chemotherapy induced cystitis

Question 28

what typee of raddiotherapy is associateedd withh RIC ?

Answer 28

EBRT / brachytherapy for pelvic neoplasms

Question 29

what are the different stages of damage associated with RIC ?

Answer 29

acute - 4 to 6 weeks
chronic - 6 months to 1 year
late - up to 10 years
after RTH

Question 30

what is the presentation of RIC ?

Answer 30

haematuria
burning
frequency
urgency
incontinence

Question 31

what is important to consider when confirming a diagnosis of RIC ?

Answer 31

based on clinical suspicion
confirmed through cystoscopy when needed
urine culture and cytology recommended to rule out other causes

Question 32

what is the treatment for RIC ?

Answer 32

placement of a urinary catheter with irrigation until the elimination of clots followed by normal saline bladder irrigation

Question 33

what chemotherapeutic agent causes cystitis ?

Answer 33

cyclophosphamide , due to acrolein

Question 34

what is the treatment for CIC ?

Answer 34

prevention is critical ass this is a preventable type
to prevent : vigorous IV hydration to reduce urine concentration of acrolein along with administration of MESNA to detoxify the acrolein

Question 35

clinical definition of acute renal failure ?

Answer 35

sudden decrease in GFR with an acute rise in blood urea nitrogen
and serum creatinine levels

Question 36

post renal failure cause ?

Answer 36

TLS
characterised by hypercalcemia , hyperuricemia , hyperphosphatemia and hyperkalemia

Question 37

most common cause of pre renal failure ?

Answer 37

hypoperfusion

Question 38

what are the available methods for urinary diversion in upper UO ?

Answer 38

• 1) Placement of percutaneous nephrostomy tubes
• 2) Addition of indwelling ureteral stents through cystoscopy
• Devices need to be changed every 3– 6 months