title: Protean presentation and multiple challenges of nephrocalcinosis in pregnancy (six pregnancies in four patients).
abstract: BACKGROUND
  Nephrocalcinosis is an umbrella term covering increased content of calcium salts in the renal parenchyma, interstitial damage and potential evolution towards renal failure. Pregnancy is often the first occasion for biochemical or imaging tests in young women and may allow early diagnosis. Conversely, even mild kidney disease may represent a challenge in pregnancy.
  
  
  OBJECTIVE
  The aim of this study was to report on four patients in whom nephrocalcinosis was first diagnosed during pregnancy, exemplifying the protean presentation and multiple challenges of nephrocalcinosis in pregnancy.
  
  
  METHODS
  This is a case series study including data on all pregnancies prospectively gathered in the Nephrological-Obstetric Unit dedicated to pregnancy and kidney diseases (2000-11).
  
  
  RESULTS
  Six pregnancies were observed in four patients (31-35 years; one twin pregnancy, one ongoing, one patient with three pregnancies). Symptoms were oedema in two (later developed in a further patient), renal functional impairment and electrolyte imbalance in two each. Two patients developed hypertension late in pregnancy. Electrolyte imbalance was life-threatening in one patient (severe acidosis, severe hyperkalaemia: 7.5 mEq/L). Delivery was by Caesarean section in three patients, preterm in one. Multiple or long hospitalizations for metabolic reasons were needed in three patients, the fourth was hospitalized for obstetric reasons. In all patients, diagnosis of nephrocalcinosis was made at ultrasounds during basic nephrological evaluation, confirmed at computerized tomography scan in three. The pathogenesis was linked to diuretic abuse in one case and to collagen disease, inborn errors and prematurity, possibly associated with diuretic misuse, in the others.
  
  
  CONCLUSIONS
  Nephrocalcinosis may have protean presentations in pregnancy. The risk of severe electrolyte derangements, oedema and hypertension warrants strict clinical surveillance.
authors: hrology, ASOU san Luigi Gonzaga, University of Turin, Turin, Italy. gbpiccoli@yahoo.it
authors: Giorgina B
authors: GB
authors: Piccoli
authors: Rossella
authors: R
authors: Attini
authors: Agostino
authors: A
authors: De Pascale
authors: Arianna
authors: A
authors: Pagano
authors: Valentina
authors: V
authors: Consiglio
authors: Stefania
authors: S
authors: Scognamiglio
authors: Federica
authors: F
authors: Vigotti
authors: Carlotta
authors: C
authors: Bossotti
authors: Evelina
authors: E
authors: Gollo
authors: Andrea
authors: A
authors: Veltri
authors: Tullia
authors: T
authors: Todros
mesh_terms: D000328:Adult; D002118:Calcium / Q000378:metabolism*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000473:pathology; D007231:Infant, Newborn; D007234:Infant, Premature; D009397:Nephrocalcinosis / Q000209:etiology* / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D059285:Pregnancy, Twin; D011379:Prognosis; D011446:Prospective Studies; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000473:pathology
chemical_list: D002118:Calcium