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HYPERCHLOREMIC ACIDOSIS AND NEPHROCALCINOSIS:  The Syndrome of Pure "Lower Nephron" Insufficiency

EZRA M. GREENSPAN, M.D.
Arch Intern Med (Chic). 1949;83(3):271-291. doi:10.1001/archinte.1949.00220320025002.
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IN RECENT years the term "nephrocalcinosis" has been used to designate cases of bilateral generalized calcification within the renal parenchyma. In many instances little importance has been attached to the particular anatomic position of the multiple renal calcifications. However, several observers1 called attention to a few rare cases of idiopathic nephrocalcinosis in which numerous submiliary, symmetric bilateral calcifications were confined to the renal pyramids. Special significance was attributed to the localization of the renal calcifications in these cases, since they were associated with a unique form of chronic renal failure. In this syndrome renal dysfunction was characterized by severe, intractable chronic hyperchloremic acidosis of months or years' duration, together with pronounced chronic polyuria, polydipsia, asthenia and either osteoporosis (adults) or "renal rickets" (children). Several therapeutic measures directed against this metabolic disorder resulted in prolonged symptomatic improvement. Lack of treatment predisposed to further deposition of calcium in the basement

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