In the proximal renal tubules, calcium reabsorption is linked to sodium and fluid reabsorption. Fine regulation of calcium reabsorption occurs in the distal tubules primarily under the influence of PTH or PTHrp (secreted from tumours), which increase calcium reabsorption.
Hypercalcaemia and hypercalciuria impair sodium and water reabsorption --> polyuria (a calcium diuresis) --> dehydration.
Dehydration --> Decreased renal blood flow and GFR + Increased proximal tubular calcium and sodium reabsorption --> further increase in serum calcium concentrations.
Anorexia, nausea, and vomiting associated with loss of circulating fluid volume exacerbate dehydration.
Immobilization caused by weakness and lethargy may exacerbate calcium resorption from bone.
If the concentration of calcium in the glomerular filtrate exceeds its solubility, calcium precipitates in the renal tubules (nephrocalcinosis) --> irreversible kidney damage.
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