Figure 510

Nephrocalcinosis in a patient with multiple myeloma. Irregular fractured hema-toxylinophilic deposits of calcium are seen in this fibrotic renal tissue. Hypercalcemia may produce serious structural changes in the kidney, resulting in acute or chronic renal failure.

Hypercalcemia is a relatively common complication of malignancy. Increased bone reabsorption is most often responsible owing to bone metastases or to the release of humoral substances such as parathyroid hormone-like peptide or cytokines such as transforming growth factor-a [32]. Secretion of calcitriol, the active form of vitamin D, also may occur in some lymphomas [33]. Renal dysfunction in the setting of hypercalcemia results from both calcium-induced constriction of the afferent arteriole and the deposition of calcium in the tubules and interstitium, leading to intratubular obstruction and secondary tubular atrophy and interstitial fibrosis [34]. Prompt treatment generally restores renal function, but irreversible damage can occur with long-standing hypercalcemia [35]. Recovery of the glomeru-lar filtration rate varies inversely with the extent of nephrocalcinosis, interstitial scarring, associated obstructive uropathy, infection, and hypertension. All the foregoing reflect the duration and severity of hypercalcemia. (From Skarin [31]; with permission.)

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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