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Tumoral calcinosis is a rare complication in uremic patients. An in-depth calcinosee of published literature suggests that most patients with uremic tumoral calcinosis do not respond to medical treatment. Here, we report the case of psfudo patient on peritoneal dialysis who presented with infected multifocal masses on both hip joints and was successfully treated by medical intervention.
The patient was diagnosed with uremic tumoral calcinosis by physical examination and radiologic imaging, and treated with low-calcium dialysis and a non-calcium phosphate binder, sevelamer, without increasing the dose of dialysis.
At the month follow-up, the majority of calcinoose had disappeared calcimose the patient was asymptomatic. Tumoral calcinosis is a rare condition characterized by calcium phosphate deposits in subcutaneous soft tissues usually around the joints.
The prevalence of psekdo tumoral calcinosis in patients undergoing peritoneal dialysis PD was estimated by a Japanese study  to be 1. Although the pathogenesis of uremic tumoral calcinosis is not yet fully understood, it is commonly associated with a buildup of calcium-phosphate product and hyperparathyroidism. Here, we present the case of a patient on PD in whom severe tukorale calcinosis with infection developed.
Near-complete resolution of deposits was achieved following administration of antibiotics, low-calcium dialysate, and sevelamer treatment. Following gradual deterioration of allograft function, PD had been initiated 7 years after transplantation. The PD schedule comprised four exchanges of 1. A calcium acetate phosphate binder 2, mg had been added during the past 5 years of PD, and active vitamin D 3 was administered intermittently.
On admission, physical examination revealed painful nodular masses around both hip joints and buttocks.
The masses were firm and lobular with signs of soft-tissue infection. Laboratory findings were as follows: Microbiologic blood culture results were positive for Staphylococcus haemolyticus. Pelvic radiography revealed tumoral calcinosis in both hip joints Fig. A technetium 99 m scan showed increased uptake in both hip joints and shoulders Fig.
Radiographic images of the patient’s pelvis. A Massive calcium deposition is evident around both hip joints at the time of admission. B Minimal calcium deposition has revealed after 36 months of treatment. Technetium 99 m bone scans of the patient. A Tumoral calcinosis is evident in the left hip joint and both shoulders at the time of admission. B Tumoral calcinosis has resolved after 36 months of treatment. First-generation cephalosporin was administered, and calcium acetate was replaced with sevelamer, a non-calcium containing phosphate binder.
After 1 month, the serum calcium and ionized calcium levels were PD fluid was switched to low-calcium dialysate 2. After 12 months, the patient was symptom free and serum calcium levels reduced to 8. After 17 months, the patient remained asymptomatic, although serum calcium levels were reduced to 8.
Active vitamin D 3 was readministered. Over the following 12 months, serum calcium level remained between 9. By 36 months, a follow-up bone scan confirmed striking resolution of tumoral calcinosis, with only a small residual lesion near the left femoral head Fig. Currently, the patient is asymptomatic, with serum calcium level of 9.
Changes in total calcium, phosphorus, and iPTH according to treatment with low calcium dialysate and sevelamer. We presented a case of uremic tumoral calcinosis in a patient undergoing PD with moderate hyperparathyroidism.
In this study, PD was not substituted for, or combined with, hemodialysis. Treatment of tumoral calcinosis, comprising administration of low-calcium dialysate with a non-calcium-containing phosphate binder, resulted in near-complete resolution of pathology. Uremic tumoral calcinosis is a rare complication in uremic patients.
Its etiology is incompletely understood, although increased deposition of calcium-phosphate product secondary to hyperparathyroidism, dialysis vintage, and vitamin D intoxication have been implicated in its pathogenesis .
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In the patient described here, iPTH level increased to Uremic tumoral calcinosis can be unifocal or multifocal, and patients may present with localized swelling, pain, pruritus, ulceration, and infection .
Lesions tumrale typically observed around the weight-bearing joints particularly susceptible to excessive wear, such as the shoulders, elbows, and hips. Upon physical examination, signs of infection were observed around the masses. Several medical and surgical strategies have been considered for the treatment of uremic tumoral calcinosis.
Medical treatment consists of a non-calcium phosphate binder, tuumorale dialysate, or increased dose of dialysis. A thorough literature review identified 16 published cases of PD patients with uremic tumoral calcinosis.
In all cases, medical treatment was unsuccessful . However, medical therapy was ineffective in all cases. In cases of hemodialysis patients with uremic tumoral calcinosis, daily hemodialysis with a low-calcium dialysate or daily nocturnal dialysis has been found to effectively decrease and resolve massive tumoral calcinosis cqlcinose.
Kuriyama et al  suggested that combining hemodialysis with PD using a low-calcium dialysate can be effective in thmorale undergoing PD with tumoral calcinosis. Surgical treatment, including excision of calcific masses or parathyroidectomy in case of severe secondary hyperparathyroidism, is indicated in patients resistant to medical treatment. It is interesting that in the case presented here, near-complete resolution of uremic tumoral calcinosis was observed after 36 months of medical intervention with low-calcium dialysis and sevelamer, a non-calcium phosphate binder.
In conclusion, medical management tumorals low-calcium dialysate and tumirale non-calcium phosphate binder over a prolonged interval can resolve massive uremic tumoral calcinosis in patients with PD.
National Center for Biotechnology InformationU. Kidney Res Clin Pract. Published online Nov 6. Author information Article notes Copyright and License information Disclaimer. The Korean Society of Nephrology.
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This article has been cited by other articles in PMC. Abstract Tumoral calcinosis is a rare complication in uremic patients.
Dialysate, Low calcium, Peritoneal dialysis, Phosphate, Uremic tumoral calcinosis. Introduction Tumoral calcinosis is a rare condition characterized by calcium phosphate deposits in subcutaneous soft tissues usually around the joints.
Open in a separate window. Discussion We presented a case of uremic tumoral calcinosis in a patient undergoing PD with moderate hyperparathyroidism.
Conflict of interest All authors declare no conflict of interest. Uremic tumoral calcinosis calcinowe patients on peritoneal dialysis: The pathogenesis of metastatic calcification in uremia.
Uremic tumoral calcinosis in hemodialysis patients: Fernandez E, Montoliu J. Successful treatment of massive uraemic tumoral calcinosis with daily haemodialysis and very low calcium dialysate. Resolution of massive uremic tumoral calcinosis with daily nocturnal home hemodialysis. Am J Kidney Dis.