Introduction: PTH is released from the parathyroid glands behind the thyroid and is the primary regulator of calcium homeostasis. Indications for surgery in hyperparathyroidism remain controversial but can include symptomatic disease, renal stones, impaired renal function, bone involvement or marked reduction in bone density. Due to hypocalcaemia post op, pre-op calcium loading should occur. However not much research has been conducted into this area.

Intractable gross hematuria without an obvious or common urologic pathology needs more effort for correct diagnosis and appropriate management. In this case, we report on a patient with intractable hematuria originating from varicose vessels of urinary bladder due to advanced venous stasis after severe cardiac failure.

Patients undergoing hemodialysis often present with a reduced response to anti-hepatitis B virus (anti-HBV) vaccination. The soluble form of CD40 (sCD40) is elevated in hemodialysis patients and this has been shown to correlate with lack of response to anti-HBV vaccination. Due to its high molecular weight, conventional dialyzers cannot clear sCD40. Previous studies have demonstrated, that dialysis membranes in polymethylmethacrylate (PMMA) can reduce the levels of sCD40. We have studied the effect of dialysis with PMMA membranes in patients who were non-responders to anti-HBV vaccination after a complete cycle of vaccinations. Interestingly, we found that significantly more patients in the PMMA group were able to mount a response to vaccination, compared to the control group (P = 0.04).

Renal (ureteric) colic is a common surgical emergency. It is usually caused by calculi obstructing the ureter, but about 15% of patients have other causes, e.g. extrinsic compression, intramural neoplasia or an anatomical abnormality [1]. Up to 12 percent of the population will have a urinary stone during their lifetime, and recurrence rates approach 50 percent [2]. Fifty-five percent of those with recurrent stones have a family history of urolithiasis [3] and having such a history increases the risk of stones by a factor of three [4]. Upon presentation to the A&E department, suspected acute renal colic patients must have a clinical examination and radiological investigations to confirm the diagnosis [5].

Primary hyperparathyroidism (PHPT) is a disease involving a broad range of alterations of calcium homeostasis, sustained by parathyroid hormone (PTH) levels that are clearly abnormal. The anomalies directly associated with hyperparathyroidism are nephrolithiasis and fibrocystic bone disease. Since PHPT resolves when abnormal parathyroid tissue is removed, surgery is clearly the only definitive approach to this type of hyperparathyroidism. However there are large subgroups of patients for whom medical therapy should be considered instead of surgery. Pharmacological therapy consists largely of biphosphonates, or calciomimetics such as cinacalcet. Recent preliminary data suggests however that cinacalcet could also be effective in the specific group of patients with primary hyperparathyroidism associated with nephrolithiasis. Finally, since cinacalcet reduces calcemia in most PHPT patients without improving bone mass, whereas biphosphonates and especially alendronate improve bone mass, it could make sense to combine the two drugs in PHPT patients with concomitant bone loss and possibly nephrolithiasis who cannot or do not wish to undergo surgery.

Numerous beneficial effects on cardiovascular health have been described for magnesium (Mg). Intradialytic hypotension (IDH) is a common complication in hemodialysis patients which contributes to cardiovascular mortality. It has been suggested that higher dialysate Mg (DMg) might reduce the risk of IDH. In this 24-month retrospective observational analysis we studied the incidence of IDH in 45 stable hemodialysis patients who underwent conversion from 0.5 mmol/L DMg to 1.0 mmol/L. Mean serum Mg was 1.12 ± 0.03 mmol/L pre-conversion and changed to 1.35 ± 0.04 mmol/L post-conversion. In parallel, incidence of IDH showed a significant decrease from 1.59 ± 0.34 to 1.08 ±0.27 % comparing 12 months before and 12 months after DMg conversion. The incidence of muscle cramps and serum calcium showed a trend for reduction while other parameters were unchanged. In conclusion, switching patients from 0.5 mmol/L DMg to 1.0 mmol/L was associated with a significant improvement of IDH incidence without significant changes in other parameters that were analyzed in this study. Further studies are warranted to test the association between DMg and IDH in a prospective randomized fashion.

Metformin is an oral antidiabetic from biguanide class and is the first-line treatment option for type 2 diabetes mellitus (DM) [1]. Most common side effects of metformin include gastrointestinal system side effects such as abdominal cramp, diarrhea, nausea and vomiting [2]. Lactic acidosis is a rare but fatal serious side effect of metformin and its incidence is found 9 in every 100.000 patient years [3]. Nevertheless, this side effect generally occurs in those who have organ dysfunction (kidney, liver, lung or heart dysfunction etc.) [3,4]. In general, it is not expected in those who have no organ dysfunction. In this article, a case of severe lactic acidosis due to metformin in a patient with type 2 DM without any organ dysfunction was presented.

Background: Diet plays a key role in the pathogenesis of kidney stones. In particular, recent findings have advanced knowledge on the protective role of a high calcium diet. However, not much is known about the specific role played by milk intake in the pathogenesis of kidney stones compared with other dairy products, especially cheese.

Introduction: Membranoproliferative glomerulonephritis has been reported to occur in association with non-Hodgkin’s lymphoma but there is few information about glomerulonephritis response to the treatment of non-Hodgkin’s lymphoma.

Here we report two cases of proliferative glomerulonephritis with monoclonal IgG deposits, a form of renal involvement by monoclonal gammopathy that mimics immune complex glomerulonephritis. Case 1 presented with incidental proteinuria and a renal biopsy showed mesangioproliferative glomerulonephritis with monoclonal IgG kappa deposits on immunofluorescence examination. He remains stable after one year follow up. Case 2 presented with rapidly progressive renal failure and renal biopsy showed rescentic membranoproliferative glomerulonephritis with monoclonal IgG kappa deposits on immunofluorescence study. He showed no response to aggressive immunosuppressive medication and plasmapheresis and remained anuric. He underwent renal transplantation three months later but disease recurred in the allograft, which was diagnosed on a biopsy one and a half months post-transplant. Extensive work up for underlying paraprotein disease was negative in both patients. Our aim is to expand awareness and highlight the heterogeneity in the clinical presentation, histology and outcome of this rare entity.

Background: The determination of resting energy expenditure (REE) in critically ill patients is essential to prevent hypo and hyper alimentation. Objectives: This study aims to describe the REE in septic patients with and without acute kidney injury (AKI) and compare by examining the REE estimated by Harris-Benedict equation (HB) with the REE measured by indirect calorimetry (IC).