Letter to the Editor
Lots of steroids and vitamins, tons of complications. Hypercalcemia and nephrocalcinosis as important complications of performance-enhancing drugs
Montones de esteroides y vitaminas, toneladas de complicaciones. Hipercalcemia y nefrocalcinosis como complicaciones importantes de los fármacos para mejorar el rendimiento
Claudia Bentoa,
, Pedro Velhob, Maurício Carvalhob
Corresponding author
claudiaqbento@gmail.com
Corresponding author at: Servicio de Nefrología, CHTMAD - Vila Real, Avenida da Noruega, Lordelo, Vila Real 5000-508, Portugal.
Corresponding author at: Servicio de Nefrología, CHTMAD - Vila Real, Avenida da Noruega, Lordelo, Vila Real 5000-508, Portugal.
Read
16600
Timeswas read the article
2510
Total PDF
14090
Total HTML
Share statistics
array:24 [ "pii" => "S2013251415000851" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2015.10.008" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "91" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2015;35:598-600" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5198 "formatos" => array:3 [ "EPUB" => 301 "HTML" => 4258 "PDF" => 639 ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251415001078" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2015.08.004" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "100" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2015;35:600-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3566 "formatos" => array:3 [ "EPUB" => 301 "HTML" => 2674 "PDF" => 591 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Valvular calcifications in chronic kidney disease: Mineral and bone disease or previous cardiovascular risk? Response" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "600" "paginaFinal" => "601" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calcificaciones valvulares en enfermedad renal crónica:¿enfermedad mineral ósea o riesgo cardiovascular previo? Respuesta" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen Sánchez Perales, Eduardo Vázquez Ruiz de Castroviejo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carmen" "apellidos" => "Sánchez Perales" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Vázquez Ruiz de Castroviejo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699515001526" "doi" => "10.1016/j.nefro.2015.08.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001526?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415001078?idApp=UINPBA000064" "url" => "/20132514/0000003500000006/v2_201703220324/S2013251415001078/v2_201703220324/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S201325141500108X" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2015.07.007" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "105" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2015;35:597-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3408 "formatos" => array:3 [ "EPUB" => 295 "HTML" => 2551 "PDF" => 562 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Valvular calcifications in CKD: Mineral and bone disease or previous cardiovascular risk?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "598" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Calcificaciones valvulares en ERC: enfermedad mineral ósea o riesgo cardiovascular previo?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandra Bocanegra-Jesús, Katia Guinetti-Ortiz, Andrea Gómez de la Torre-del Carpio" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alejandra" "apellidos" => "Bocanegra-Jesús" ] 1 => array:2 [ "nombre" => "Katia" "apellidos" => "Guinetti-Ortiz" ] 2 => array:2 [ "nombre" => "Andrea" "apellidos" => "Gómez de la Torre-del Carpio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699515001575" "doi" => "10.1016/j.nefro.2015.07.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001575?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S201325141500108X?idApp=UINPBA000064" "url" => "/20132514/0000003500000006/v2_201703220324/S201325141500108X/v2_201703220324/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Lots of steroids and vitamins, tons of complications. Hypercalcemia and nephrocalcinosis as important complications of performance-enhancing drugs" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "598" "paginaFinal" => "600" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Claudia Bento, Pedro Velho, Maurício Carvalho" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Claudia" "apellidos" => "Bento" "email" => array:1 [ 0 => "claudiaqbento@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro" "apellidos" => "Velho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Maurício" "apellidos" => "Carvalho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, CHTMAD - Vila Real, Vila Real, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de clinicas, Curitiba, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>: Servicio de Nefrología, CHTMAD - Vila Real, Avenida da Noruega, Lordelo, Vila Real 5000-508, Portugal." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Montones de esteroides y vitaminas, toneladas de complicaciones. Hipercalcemia y nefrocalcinosis como complicaciones importantes de los fármacos para mejorar el rendimiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1582 "Ancho" => 2333 "Tamanyo" => 296529 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of physical tone during hospitalization.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic hypercalcemia can be an important complication of anabolic steroid and vitamin supplement abuse. We report the case of a 30-year-old bodybuilder that for more than 4 years used injectable anabolic-androgenic steroids (AAS) and one veterinary polyvitamin formulation with vitamin A (2,100,000<span class="elsevierStyleHsp" style=""></span>IU), D (ergocalciferol: 60,000<span class="elsevierStyleHsp" style=""></span>IU), and E (55<span class="elsevierStyleHsp" style=""></span>IU) on a monthly basis. He also reported self-injecting mineral oil intramuscularly for esthetic purposes for more than 2 years. He presented to the emergency room with an acute, severe epigastric pain, associated with nausea and vomiting. Laboratory evaluation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) demonstrated an elevated amylase 2500<span class="elsevierStyleHsp" style=""></span>IU/L (50–160<span class="elsevierStyleHsp" style=""></span>IU/L); lipase of 612<span class="elsevierStyleHsp" style=""></span>IU/L (0–75<span class="elsevierStyleHsp" style=""></span>IU/L); a corrected serum calcium of 12.5<span class="elsevierStyleHsp" style=""></span>mg/dL (8.5–10.5<span class="elsevierStyleHsp" style=""></span>mg/dL); PTH of 73.2<span class="elsevierStyleHsp" style=""></span>pg/mL (15–68.3<span class="elsevierStyleHsp" style=""></span>pg/mL) and 25(OH)D of 65.1<span class="elsevierStyleHsp" style=""></span>ng/mL (30–100<span class="elsevierStyleHsp" style=""></span>ng/mL). Serum creatinine was 1.2<span class="elsevierStyleHsp" style=""></span>mg/dL (0.6–1.2<span class="elsevierStyleHsp" style=""></span>mg/dL). Abdominal ultrasound showed a diffusely edematous pancreas, bilateral ureterolithiasis and nephrocalcinosis. A high-resolution CT of the chest and abdomen was performed and revealed absence of granulomas and lymphadenopathies. He had a tormented clinical course, with acute kidney injury (attributed to volume depletion and renal vasoconstriction in the setting of hypercalcemia) without the need of hemodialysis; protracted vomiting that lead to a laparoscopic duodenum–jejunum anastomosis with improvement of complains and multiple infectious complications. Serum calcium and PTH returned to normal levels (9<span class="elsevierStyleHsp" style=""></span>mg/dL and 35<span class="elsevierStyleHsp" style=""></span>pg/mL, respectively) after vitamin D discontinuation, vigorous venous hydration with 0.9% saline infusion and therapy with furosemide and corticosteroids. After more than 60 days of hospitalization he was discharged home having made a full recovery.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">With the desire to improve performance, some athletes or amateurs use performance-enhancing drugs. The widespread use of these substances without medical prescription or clinical follow-up can lead to serious health problems as described on several reports.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> We believe that the main clinical features seen in this patient are due to chronic hypercalcemia due to multiple substance abuse and paraffinomas. The association between focal segmental glomerulosclerosis and anabolic steroids abuse may be explained by increase in lean body mass and potential direct nephrotoxic effects of anabolic steroids.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Furthermore, this drug modulates steroid hydroxylase activity predisposing to hypercalcemia.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The association of vitamin A toxicity and hypercalcemia is rare but well recognized. It is attributed to a direct effect on bone (activation of bone reabsorption with increased osteoclast activity),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> on the parathyroid, or in both.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> According to Chertow et al., vitamin A stimulate PTH secretion in bovine parathyroid tissue and in men.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> The minimum dose of vitamin A required to produce hypercalcemia cannot be stated with certainty; toxicity has been described from doses ranging from 50,000 to 500,000<span class="elsevierStyleHsp" style=""></span>IU/day.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Although we did not measure the value of vitamin A in blood, the patient injected more than 2,100,000<span class="elsevierStyleHsp" style=""></span>IU/month (which correspond 70.000<span class="elsevierStyleHsp" style=""></span>IU of vitamin A/day) for more than 4 years, which is compatible with toxicity. Hypercalcemia is a well-known but uncommon complication of vitamin D intake.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Usually results from doses that exceed 10,000<span class="elsevierStyleHsp" style=""></span>IU/day, and is generally associated with serum levels of 25-hydroxyvitamin D that are well above 150<span class="elsevierStyleHsp" style=""></span>ng/mL.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In this case, 60,000<span class="elsevierStyleHsp" style=""></span>IU of ergocalciferol were inject monthly and serum vitamin D was in the upper limit of normal. The tolerable upper level of daily vitamin D intake recently set by the Institute of Medicine is 4000<span class="elsevierStyleHsp" style=""></span>IU.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Vitamin A and D can act synergistically to cause hypercalcemia. Contrary to what we were expecting, the patient described here presented with hypercalcemia and moderated increased serum PTH, instead of suppression of the activity of this hormone by multidrug and vitamin abuse. Multifactorial mechanisms may be involved and some possible explanations are: vitamin A intoxication may have had a leading role in the development of hypercalcemia and itself may increase PTH secretion<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>; parathyroid overactivity has been described in critical illness associated with sepsis and renal failure (life-threatening tertiary hyperparathyroidism).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Primary hyperparathyroidism from adenoma or hyperplasia was excluded by negative imaging studies and the restoration of serum calcium and PTH to normal levels after discontinuation of the drugs. Finally, in the case reported here there was a peculiar involvement of the neck and the arms due to self-injection of mineral oil, more apparent after the significant weight loss observed (more than 30<span class="elsevierStyleHsp" style=""></span>kg) by the patient (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Biopsy of the affected skin revealed multinucleated giant cells and inflammatory infiltrates. These lesions, called paraffinomas, may have contributed to hypercalcemia due to PTH-independent, extrarenal production of 1,25-dihydroxy-vitamin D by activated mononuclear cells.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion, clinicians need to be aware that AAS and multivitamin abuse can occur with relative frequency and their use can be surreptitious. The simultaneous occurrence of nephrocalcinosis, nephrolithiasis, acute kidney injury and acute pancreatitis may be a clue to the diagnosis of associated chronic hypercalcemia.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-07-19" "fechaAceptado" => "2015-04-13" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1582 "Ancho" => 2333 "Tamanyo" => 296529 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of physical tone during hospitalization.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reference range \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">On admission \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">One week \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Two weeks \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">At discharge \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3–18.3<span class="elsevierStyleHsp" style=""></span>g/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.8<span class="elsevierStyleHsp" style=""></span>g/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6–1.2<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20–44<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">125 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lipase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0–75<span class="elsevierStyleHsp" style=""></span>IU/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">612 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">456 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">321 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amylase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50–160<span class="elsevierStyleHsp" style=""></span>IU/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1430 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">234 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corrected Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.5–10.5<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9–5.2<span class="elsevierStyleHsp" style=""></span>g/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15–68.3<span class="elsevierStyleHsp" style=""></span>pg/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25-OH-VIT D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30–100<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phosphorus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5–4.5<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglyceride \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50–200<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">185 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1375546.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Laboratory evaluation</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of focal segmental glomerulosclerosis after anabolic steroid abuse" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.C. Herlitz" 1 => "G.S. Markowitz" 2 => "A.B. Farris" 3 => "J.A. Schwimmer" 4 => "M.B. Stokes" 5 => "C. Kunis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2009040450" "Revista" => array:7 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2010" "volumen" => "21" "numero" => "1" "paginaInicial" => "163" "paginaFinal" => "172" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19917783" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis, acute renal failure, and death after monensin ingestion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Caldeira" 1 => "W.S. Neves" 2 => "P.M. Cury" 3 => "P. Serrano" 4 => "M.A. Baptista" 5 => "E.A. Burdmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/ajkd.2001.28618" "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2001" "volumen" => "38" "numero" => "5" "paginaInicial" => "1108" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11684567" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury due to anabolic steroid and vitamin supplement abuse: report of two cases and a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.F. Daher" 1 => "G.B. Silva Junior" 2 => "A.L. Queiroz" 3 => "L.M. Ramos" 4 => "S.Q. Santos" 5 => "D.M. Barreto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11255-009-9571-8" "Revista" => array:8 [ "tituloSerie" => "Int Urol Nephrol" "fecha" => "2009" "volumen" => "41" "numero" => "3" "paginaInicial" => "717" "paginaFinal" => "723" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19387860" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1878875015015880" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multi-organ damage induced by anabolic steroid supplements: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.A. Samaha" 1 => "W. Nasser-Eddine" 2 => "E. Shatila" 3 => "J.J. Haddad" 4 => "J. Wazne" 5 => "A.H. Eid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1752-1947-2-340" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2008" "volumen" => "2" "paginaInicial" => "340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18976461" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The acute and chronic toxic effects of vitamin A" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.L. Penniston" 1 => "S.A. Tanumihardjo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2006" "volumen" => "83" "numero" => "2" "paginaInicial" => "191" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16469975" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of vitamin A toxicity on calcium and lipid metabolism in chronic renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Miller" 1 => "P. Sweny" 2 => "J.W. Persaud" 3 => "Z. Varghese" 4 => "K. Farrington" 5 => "M.K. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Proc Eur Dial Transplant Assoc" "fecha" => "1981" "volumen" => "18" "paginaInicial" => "573" "paginaFinal" => "578" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7036172" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1878875016305162" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamin A stimulation of parathyroid hormone: interactions with calcium, hydrocortisone, and vitamin E in bovine parathyroid tissues and effects of vitamin A in man" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.S. Chertow" 1 => "G.A. Williams" 2 => "R.M. Norris" 3 => "G.R. Baker" 4 => "G.K. Hargis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Eur J Clin Invest" "fecha" => "1977" "volumen" => "7" "numero" => "4" "paginaInicial" => "307" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/408151" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice. Vitamin D insufficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.J. Rosen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMcp1009570" "Revista" => array:8 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "numero" => "3" "paginaInicial" => "248" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21247315" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1529943010012246" "estado" => "S300" "issn" => "15299430" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Life-threatening tertiary hyperparathyroidism in the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.C. Jeffries" 1 => "A.M. Ledgerwood" 2 => "C.E. Lucas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjsurg.2004.11.025" "Revista" => array:7 [ "tituloSerie" => "Am J Surg" "fecha" => "2005" "volumen" => "189" "numero" => "3" "paginaInicial" => "369" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15792772" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Pubmed]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe hypercalcaemia, nephrocalcinosis, and multiple paraffinomas caused by paraffin oil injections in a young bodybuilder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Gyldenlove" 1 => "S. Rorvig" 2 => "L. Skov" 3 => "D. Hansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)60806-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "383" "numero" => "9934" "paginaInicial" => "2098" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24931692" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003500000006/v2_201703220324/S2013251415000851/v2_201703220324/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000006/v2_201703220324/S2013251415000851/v2_201703220324/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000851?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 13 | 23 |
| 2024 October | 161 | 70 | 231 |
| 2024 September | 151 | 52 | 203 |
| 2024 August | 173 | 89 | 262 |
| 2024 July | 167 | 35 | 202 |
| 2024 June | 123 | 53 | 176 |
| 2024 May | 150 | 33 | 183 |
| 2024 April | 122 | 35 | 157 |
| 2024 March | 113 | 21 | 134 |
| 2024 February | 137 | 43 | 180 |
| 2024 January | 149 | 27 | 176 |
| 2023 December | 151 | 29 | 180 |
| 2023 November | 234 | 27 | 261 |
| 2023 October | 242 | 25 | 267 |
| 2023 September | 152 | 26 | 178 |
| 2023 August | 183 | 37 | 220 |
| 2023 July | 173 | 50 | 223 |
| 2023 June | 181 | 31 | 212 |
| 2023 May | 224 | 43 | 267 |
| 2023 April | 267 | 18 | 285 |
| 2023 March | 228 | 24 | 252 |
| 2023 February | 197 | 26 | 223 |
| 2023 January | 221 | 30 | 251 |
| 2022 December | 179 | 27 | 206 |
| 2022 November | 224 | 29 | 253 |
| 2022 October | 200 | 31 | 231 |
| 2022 September | 212 | 21 | 233 |
| 2022 August | 188 | 42 | 230 |
| 2022 July | 147 | 48 | 195 |
| 2022 June | 178 | 29 | 207 |
| 2022 May | 230 | 31 | 261 |
| 2022 April | 207 | 58 | 265 |
| 2022 March | 264 | 48 | 312 |
| 2022 February | 227 | 40 | 267 |
| 2022 January | 249 | 31 | 280 |
| 2021 December | 196 | 37 | 233 |
| 2021 November | 169 | 46 | 215 |
| 2021 October | 216 | 34 | 250 |
| 2021 September | 152 | 30 | 182 |
| 2021 August | 193 | 36 | 229 |
| 2021 July | 195 | 31 | 226 |
| 2021 June | 146 | 26 | 172 |
| 2021 May | 218 | 35 | 253 |
| 2021 April | 389 | 53 | 442 |
| 2021 March | 216 | 48 | 264 |
| 2021 February | 141 | 19 | 160 |
| 2021 January | 110 | 19 | 129 |
| 2020 December | 107 | 25 | 132 |
| 2020 November | 101 | 22 | 123 |
| 2020 October | 93 | 21 | 114 |
| 2020 September | 108 | 14 | 122 |
| 2020 August | 80 | 20 | 100 |
| 2020 July | 101 | 13 | 114 |
| 2020 June | 120 | 12 | 132 |
| 2020 May | 117 | 20 | 137 |
| 2020 April | 117 | 25 | 142 |
| 2020 March | 98 | 7 | 105 |
| 2020 February | 93 | 21 | 114 |
| 2020 January | 126 | 15 | 141 |
| 2019 December | 228 | 11 | 239 |
| 2019 November | 124 | 25 | 149 |
| 2019 October | 80 | 9 | 89 |
| 2019 September | 140 | 22 | 162 |
| 2019 August | 106 | 16 | 122 |
| 2019 July | 90 | 25 | 115 |
| 2019 June | 82 | 12 | 94 |
| 2019 May | 94 | 14 | 108 |
| 2019 April | 100 | 31 | 131 |
| 2019 March | 85 | 37 | 122 |
| 2019 February | 66 | 16 | 82 |
| 2019 January | 65 | 17 | 82 |
| 2018 December | 178 | 34 | 212 |
| 2018 November | 188 | 21 | 209 |
| 2018 October | 198 | 11 | 209 |
| 2018 September | 128 | 19 | 147 |
| 2018 August | 102 | 12 | 114 |
| 2018 July | 102 | 9 | 111 |
| 2018 June | 82 | 8 | 90 |
| 2018 May | 94 | 14 | 108 |
| 2018 April | 78 | 3 | 81 |
| 2018 March | 102 | 10 | 112 |
| 2018 February | 84 | 11 | 95 |
| 2018 January | 60 | 4 | 64 |
| 2017 December | 129 | 6 | 135 |
| 2017 November | 61 | 7 | 68 |
| 2017 October | 54 | 11 | 65 |
| 2017 September | 45 | 11 | 56 |
| 2017 August | 39 | 13 | 52 |
| 2017 July | 33 | 17 | 50 |
| 2017 June | 49 | 17 | 66 |
| 2017 May | 46 | 12 | 58 |
| 2017 April | 35 | 12 | 47 |
| 2017 March | 28 | 35 | 63 |
| 2017 February | 39 | 19 | 58 |
| 2017 January | 23 | 16 | 39 |
| 2016 December | 32 | 7 | 39 |
| 2016 November | 45 | 12 | 57 |
| 2016 October | 53 | 8 | 61 |
| 2016 September | 77 | 7 | 84 |
| 2016 August | 73 | 3 | 76 |
| 2016 July | 127 | 5 | 132 |
| 2016 June | 84 | 0 | 84 |
| 2016 May | 139 | 0 | 139 |
| 2016 April | 88 | 0 | 88 |
| 2016 March | 79 | 0 | 79 |
| 2016 February | 40 | 0 | 40 |
Show all
