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      Nefrocalcinosis, un hallazgo casual, pero un signo guía Translated title: Nephrocalcinosis, a casual finding, a guiding sign

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          Abstract

          Resumen Se presenta el caso de una niña de diez años diagnosticada de nefrocalcinosis bilateral tras un estudio radiológico solicitado por sospecha de escoliosis. El estudio de sangre y orina inicial nos orienta hacia el diagnóstico de una rara enfermedad, como es el síndrome de hipomagnesemia familiar con hipercalciuria y nefrocalcinosis. El diagnóstico genético dirigido solicitado en ámbito hospitalario confirma el diagnóstico y permite iniciar el tratamiento.

          Translated abstract

          Abstract We present the case of a ten-year-old girl diagnosed with bilateral nephrocalcinosis after a radiological study requested for suspected scoliosis. The initial blood test and urine test guided us to the diagnosis of the rare disease called familial hypomagnesemia syndrome with hypercalciuria and nephrocalcinosis. The genetic diagnosis requested in the hospital confirms the diagnosis and allows to start the treatment.

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          Normal 25-Hydroxyvitamin D Levels Are Associated with Less Proteinuria and Attenuate Renal Failure Progression in Children with CKD.

          Angiotensin-converting enzyme inhibitors (ACEi) for renin-angiotensin-aldosterone system (RAAS) blockade are routinely used to slow CKD progression. However, vitamin D may also promote renoprotection by suppressing renin transcription through cross-talk between RAAS and vitamin D-fibroblast growth factor-23 (FGF-23)-Klotho pathways. To determine whether vitamin D levels influence proteinuria and CKD progression in children, we performed a post hoc analysis of the Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of CKD in Pediatric Patients (ESCAPE) cohort. In 167 children (median eGFR 51 ml/min per 1.73 m(2)), serum 25-hydroxyvitamin D (25(OH)D), FGF-23, and Klotho levels were measured at baseline and after a median 8 months on ACEi. Children with lower 25(OH)D levels had higher urinary protein/creatinine ratios at baseline (P=0.03) and at follow-up (P=0.006). Levels of 25(OH)D and serum vitamin D-binding protein were not associated, but 25(OH)D ≤50 nmol/L associated with higher diastolic BP (P=0.004). ACEi therapy also associated with increased Klotho levels (P<0.001). The annualized loss of eGFR was inversely associated with baseline 25(OH)D level (P<0.001, r=0.32). Five-year renal survival was 75% in patients with baseline 25(OH)D ≥50 nmol/L and 50% in those with lower 25(OH)D levels (P<0.001). This renoprotective effect remained significant but attenuated with ACEi therapy (P=0.05). Renal survival increased 8.2% per 10 nmol/L increase in 25(OH)D (P=0.03), independent of eGFR; proteinuria, BP, and FGF-23 levels; and underlying renal diagnosis. In children with CKD, 25(OH)D ≥50 nmol/L was associated with greater preservation of renal function. This effect was present but attenuated with concomitant ACEi therapy.
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            Retrospective cohort study of familial hypomagnesaemia with hypercalciuria and nephrocalcinosis due to CLDN16 mutations.

            Familial hypomagnesaemia with hypercalciuria and nephrocalcinosis (FHHNC) is a rare autosomal recessive tubular disorder exhibiting a high risk for progressive chronic kidney disease (CKD).
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              Clinical utility gene card for: Familial hypomagnesemia with hypercalciuria and nephrocalcinosis with/without severe ocular involvement.

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                Author and article information

                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid, Madrid, Spain )
                1139-7632
                December 2019
                : 21
                : 84
                : 389-391
                Affiliations
                [3] Valencia orgnameCentro de Salud Guillem de Castro España
                [2] Valencia orgnameCentro de Salud Nou Moles España
                [1] Valencia orgnameConsorcio Hospital General de Valencia orgdiv1Servicio de Pediatría España
                Article
                S1139-76322019000400011 S1139-7632(19)02108400011
                c5249497-afd5-4e26-a667-0cc9ebc937a1

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 6, Pages: 3
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                SciELO Spain

                Categories
                Notas Clínicas

                Nefrocalcinosis,Hypercalciuria,Hypomagnesemia,Hipomagnesemia,Hipercalciuria,Nephrocalcinosis

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