Abstract: FR-PO631
Gastrointestinal Bleeding Secondary to Gastric Mucosal Calcinosis in an ESRD Patient
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
- 703 Dialysis: Peritoneal Dialysis
Authors
- Malik, Anum, Cleveland Clinic, Beachwood, Ohio, United States
- Taliercio, Jonathan J., Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
- Ferreira Provenzano, Laura, Cleveland Clinic, Beachwood, Ohio, United States
Introduction
Gastric mucosal calcinosis (GMC) is a pathological process of calcium salt deposition in normal tissues from prolonged periods of hypercalcemia or hyperphosphatemia. The gastric mucosa, kidneys and lungs are preferred sites for deposition. We describe a rare case of upper gastrointestinal bleeding (UGIB) secondary to GMC in a peritoneal dialysis (PD) patient.
Case Description
A 21 year old male with a history of ESRD secondary to anti-glomerular basement membrane disease on PD was transferred to our facility for work up of an UGIB. He has a complex cardiac history including congenital transposition of the great arteries requiring surgical repair in childhood and left ventricular thrombus on warfarin. He was listed for a combined heart-kidney transplant. He presented to the emergency department due to a syncopal episode which was attributed to hemorrhagic shock upon discovery of a hemoglobin 5.2g/dL from a baseline 9 g/dL and guaiac positive stools. His INR was 5.9 and his coagulopathy was reversed and transfused blood. An EGD demonstrated non-bleeding gastric ulcers which were biopsied. Pathology revealed diffuse calcification of the lamina propria with a mononuclear inflammatory infiltrate diagnostic of GMC.
On review of his dialysis and bone mineral disease (BMD) history he a low average transporter without residual renal function on PD for 3 years. PD prescription was 10 hours of CCPD with 8 exchanges, fill volume of 1.8L of 2.5% dextrose dialysate per exchange, with a last fill of 1.5L of 2.5% dextrose. His last Kt/V was consistently > 1.7 for the last year. His serum calcium levels have been within goal but he has been hyperphosphatemic with average level of 8-9mg/dL and PTH 501 pg/ml attributable to noncompliance with multiple calcium and non-calcium binders. He had no signs of calciphylaxis. Despite these findings, he continues to do well post discharge.
Discussion
We report a unique case of GMC in the setting of hyperphosphatemia in an ESRD patient with a dialysis vintage of only 3 years and an adequate Kt/V. On literature review, there is no other reported cases of GMC in a PD patient and only one reported case in a hemodialysis patient. Our case also highlights the importance of recognizing GMC as an possible etiology of UGIB in ESRD patients, especially those with poorly controlled BMD.