Abstract: FR-PO637
Dramatic Improvement in Dialysis Related Tumoral Calcinosis Following Renal Transplantation
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Moe, Win Win, NYU Winthrop Hospital, Mineola, New York, United States
- Nayyar, Kamal, NYU Winthrop Hospital, Mineola, New York, United States
- Zhao, Ruby, NYU Winthrop Hospital, Mineola, New York, United States
- Miyawaki, Nobuyuki (Bill), NYU Winthrop Hospital, Mineola, New York, United States
- Drakakis, James, NYU Winthrop Hospital, Mineola, New York, United States
Introduction
Tumoral calcinosis (TC) is an uncommon and serious complication of dialysis. It is usually associated with high serum calcium and phosphorus product. Management of this ectopic calcification syndrome involves dietary phosphorus restriction, non-calcium based binders, low calcium dialysis, and parathyroidectomy. Here, we present a case of extensive TC which failed to respond to conservative measures in a patient on long-standing dialysis, only clinically and radiographically improved after a successful renal transplant.
Case Description
A 56 year old male with history of HIV on HAART therapy with resultant end-stage-renal-disease (ESRD) on dialysis for 8 years, presented with hip pain and difficulty ambulating. CT scan revealed abundant metastatic calcium deposition within the adductor compartment of the right thigh, enlarging within the vastus intermedius and iliopsoas tendon and invading the femur. Biopsy revealed benign fibrous tissue and marked granular calcification. He was initially on hemodialysis (HD) but later switched to peritoneal dialysis (PD) due to limited vascular access. While on PD, clearances were sub-optimal and phosphorus ranged 8-10 mg/dL. PTH was elevated (300-400 pg/mL) despite attempts to suppress with calcimimetic. He then switched back to an intense HD regimen via a femoral dialysis catheter and was given low calcium dialysate and sodium thiosulfate. However, he did not improve and a request for medical urgency to receive compassionate points on the deceased donor wait list was filed. Shortly after, he received a functioning kidney transplant and imaging began to show resolution. In fact, a CT scan done 3 years later revealed the deposition to be 2.9 x 1.0 x 3.2 cm, compared with14 x 14 x 10 cm at time of initial diagnosis.
Discussion
There is known morbidity associated with extraosseous tumoral calcification associated with ESRD, often carrying with it a poor prognostic significance. Several medical and surgical (i.e, parathyroidectomy) treatment options are available, but responses may be limited. Renal transplantation has been described as being useful to treat TC and several cases of complete dissolution have been reported. This case similarly illustrates success after kidney transplantation and highlights the need for awareness in diagnosis and urgency to help facilitate an effective treatment strategy.