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Calciphylaxis is a rare and severe condition, characterized by calcification and thrombosis of small vessels, mainly affecting the skin. It is most often described in patients with end-stage renal disease on dialysis. Rarer cases of non-uremic calciphylaxis are reported. The prognosis is grim and the treatment is not well codified. Sodium thiosulfate has been used for more than a decade in the treatment of uremic calciphylaxis and has been shown to be effective. Its use in non-uremic cases has been reported in a few rare observations. Rheopheresis is a technique very recently used as an adjuvant treatment in uremic calciphylaxis. We describe a case of non-uremic calciphylaxis in a patient with normal renal function and with calcium supplementation. Sodium thiosulfate was introduced, then discontinued due to the patient's poor tolerance for this treatment. Rheopheresis was then used and allowed the acceleration of healing process and a significant reduction in pain. These two treatments are promising, larger studies are needed to establish their effectiveness in non-uremic calciphylaxis., (Copyright © 2020 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Osteoporosis and cardiovascular diseases are epidemiologically associated. Calcification phenomena of atherosclerotic plaque involve cytokines and growth factors also involved in bone remodeling. Drugs given for either of these two conditions could act on these mechanisms. Can osteoporosis drugs have an influence on the occurrence of cardiovascular events? Conversely, can the treatment of hypertension alter the course of osteoporosis? It is possible that administration of high doses of calcium (1g/day) in patients who already have important dietary intake can increase the risk of myocardial infarction. Epidemiological studies show links between low serum vitamin D levels and cardiovascular disease but interventional studies show that vitamin D administration in moderately deficient subjects vitamin D does not prevent the occurrence of cardiovascular events. Cohort studies show a beneficial effect of beta-blockers and thiazides administered to hypertensive patients: they reduce by 20% risk of fracture of the proximal femur. Should we focus on these anti-hypertensive treatments for our patients with osteoporosis?, (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Due to technical requirements and cost, hemodiafiltration (HDF) is not widely used in pediatrics. We have been using online HDF (oHDF) since 2009 and we observed low parathyroid hormone (PTH) levels despite the accurate management of CKD-MBD., Methods: We reviewed the medical charts and parameters of mineral metabolism assessed on a before/after session basis in the 6 children undergoing chronic oHDF in our centre., Results: We observed low (<80pg/mL) PTH levels in all 6 patients and very low (<45pg/mL) PTH levels in 5, two of them presenting with pathological fractures. These low PTH levels were reversed after decreasing calcium concentration to 1.25 mmol/L in the dialysate, suggesting that high-efficiency oHDF may expose children to calcium during sessions in a too important amount when using 1.5 mmol/L dialysates. Last, C-terminal FGF23 levels before sessions were relatively low (<1600RU/mL), with a 32% clearance by oHDF., Conclusion: PTH levels should be closely monitored in pediatric oHDF and solutions with a calcium concentration of 1.25 mmol/L should be used as first line in these patients., (Copyright © 2013 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Background: Subcutis calcinosis, characterized by abnormal calcium deposition in the skin, is a rare side effect of calcium containing heparins., Patients and Methods: Two patients with renal failure presented skin lesions after receiving a calcium-containing heparin treatment. The first patient exhibited erythematous nodules on the abdomen and the second a large erythematous induration of the abdomen and nodules on the thighs. Both had normal blood analysis. The diagnosis of subcutis calcinosis was confirmed by the histological exam showing calcium deposit in the dermis and hypodermis. Outcome was unfavourable in one of the patients who developed a superinfection and skin necrosis lesion requiring surgery at 2 months., Discussion: Subcutis calcinosis is a rare and probably underdiagnosed disease. To our knowledge, only 10 cases have been reported. The pathogenesis is not well-known, tissue damage and calcium disorders are considered as risk factors. The differential diagnoses that can be suspected include calciphylaxis, such as calcifying panniculitis and other local side effects of heparins. Outcome is usually favourable without treatment., Conclusion: We describe two cases of iatrogenic subcutis calcinosis after injections of calcium-containing heparins, including the second case of poor outcome. Clinicians should be aware of this adverse effect since other heparins such as fondaparinux or low-weight molecular heparins are contraindicated in patients with renal failure, leading to a large prescription of calcium-containing heparins in this population.

Methylcyclopentadienyl manganese tricarbonyl (MMT) has been used in Canada since 1976 as an additive in unleaded gasoline. The combustion of MMT leads to the emission of Mn oxides to the environment and may represent a potential risk to public health. It therefore seems important to assess the associated Mn exposure. The present study is part of a broader research program on total human exposure to Mn and aims specifically at assessing the level of exposure to Mn and other metals via drinking water. A comparative study was performed between two groups of workers (garage mechanics and blue collar workers of the University of Montreal) differentiated by their exposure to inhaled Mn. For Pb, Cu and Zn in residential tap water, significant differences were observed between the first sample and the one taken after one minute of flow. A significant difference was also found between the two groups of workers (combined flow time) for Mn, Cu and Ca. The Mn contribution from water is estimated to be 1% of the total dose from ingested food. This low exposure may become important (17%) for persons drinking well water, especially if we consider interactions between metals following multimedia exposure.

Drug-induced urinary calculi are rarely observed. However, it is useful to know this etiology. A complete anamnesis of drugs and dosages is mandatory if a patient presents with lithiasis, since some pharmacotherapies may carry an enhanced lithogenic risk. The list of lithogenic drugs is discussed. In order to yield preventive data, infrared, spectrophotometry is the best available analytic method.

The present long life of women raises the problem of prevention against osteoporosis. Bone mass formation during adolescence is the first critical period, and it might condition the future bone mineral content. Eighty percent of the bone mass is of genetic origin, whereas 20 percent depends on the environment (diet, hormones, etc.). Menstrual disorders may be responsible for bone mineral loss. Pregnancy and breast-feeding are periods in which calcium requirements increase, yet in all but high risk women there are seldom responsible for osteopoenia. The first 10 years of menopause constitute a period of exponential bone mineral loss, and this is when oestrogen therapy is most effective against bone loss. The usefulness of calcium is still a matter of debate, with conflicting results concerning its preventive action on osteoporosis. There seems to be a threshold phenomenon: when normal diet provides a small amount of calcium, calcium supplementation is effective, but beyond a certain level supplementation is thought to be useless. The results found in the literature are presented, and the amounts of calcium intakes recommended at different ages are given.

The authors report on a case of vegetating bromoderma observed after therapy with bromocalcic speciality (Calcibronat). Repeated bromine determinations in body fluids enabled, while reconsidering the metabolism of this halogen, to monitor its elimination.

The authors report a case of vitamin resistant osteomalacia in an adult due to an apparently acquired absence of hepatic hydroxylation of vitamin D. This case was also of interest as the osteomalacia caused a state of type II pseudo-hypoparathyroidism which proved reversible on calcium drip. Thus a defect of hepatic hydroxylation of vitamin D may be a cause of vitamin resistant osteomalacia in the adult apart from the forms already described related to defect of renal hydroxylation of vitamin D. Hypocalcemia may be responsible for hypoparathyroidism due to the coexistence of a rise of circulating immuno-reactive PTH and an increase in urinary cyclic AMP. Normalisation of the calcemia permitted in this case, restoral of the efficacy of endogenous PTH.