高血鈣、hypercalcemia、sarcoidosis

Monday, September 16, 2013

Renal Fellow Network: Kidney Biopsy Case: AKI http://renalfellow.blogspot.com/2013/09/kidney-biopsy-case-aki.html?spref=tw

Kidney Biopsy Case: AKI

這文章很有趣，患者 baseline serum creatinine of 1.3 mg/dl and 0.5 g/day proteinuria. His medications were unremarkable except for a calcium and vitamin D preparation which he had been taking for several months. （註：國外對CKD的防治，或是治療，真的還比我們先進或是說更早，以上面這樣的狀況時，就開立鈣片和vitamin D了。）

然而，因為這樣的狀況，他來做腎切片了，His creatinine was 4.0 mg/dL and calcium was 13.5 mg/dl on presentation。

腎切片結果是sarcoidosis-related granulomatous interstitial nephritis。用了口服類固醇治療後，腎指數(creatinine)和高血鈣就漸漸改善了。

然而，最後一段吸引了我注意，「A teaching point for this case is not to presume the hypercalcemia is all iatrogenic. 」是的，雖然患者之前是有服用鈣片，但不代表高血鈣就是鈣片所引起的，還是有可能其他因素，例如sarcoidosis, 甚至TB, multiple myeloma等。每次看到洗腎患者每月的抽血報告若是有高血鈣，我們也是要小心去注意是否有除了藥物之外的疾病因素。