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Abstract: SA-PO319

When Woman Turns to Stone: Extraosseous Calcification in a Dialysis Patient

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Alves, Italo Rafael Correia, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Xavier, Lucas Silva, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Santos, Thais OC, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Costa, Denise Maria Do Nascimento, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Gueiros, Jose Edevanilson, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Gueiros, Ana Paula, Hospital das Clinicas, Recife, Pernambuco, Brazil
Introduction

Extraosseous calcification (EC) involves vascular and soft tissue calcification, calciphylaxis and is a serious complication of chronic kidney disease (CKD), associated with mortality. EC is an active process arising from the complex interrelationship between electrolyte levels, cell differentiation, and dysregulation of many biochemical pathways. We report the case of a patient with diffuse EC.

Case Description

A female, aged 43, CKD of unknown etiology, on hemodialysis for four years. One year ago, the patient felt pain in the lower limbs, muscle weakness and hard edema in the legs. Seven months ago, she stopped walking, with disabling muscle weakness. On examination, edema in the lower limbs, palpable diffusely hardened nodules, and increased volume and pain in the right clavicle. No calciphylaxis. Admission exams (March 2023): intact parathyroid hormone (iPTH pg/dL) 4296, total alkaline phosphatase 706 U/L, calcium (mg/dL) 13, and phosphorus (mg/dL) 5.4. She was on paricalcitol 15 μg/wk and sevelamer 7.2 g/day. She has never tolerated cinacalcet. Previous exams confirmed a 2-year progressive increase in iPTH from 658 to 4296, monthly calcium average of 14 and phosphorus of 5.9. Paricalcitol was withdrawn. Radiology: extensive calcifications in the subcutaneous tissue of the legs and thighs, bilateral fracture of the femoral neck, brown tumor in the right clavicle, calcifications in the abdominal aorta and iliac arteries and calcifications in the mitral and aortic valves. Ophthalmology: calcifications in lower conjunctiva. Bone densitometry T score: lumbar spine -5.2 and femoral neck -4.2. Scintigraphy: capture in inferior parathyroids. The patient is awaiting parathyroidectomy.

Discussion

This is an unusual case of severe EC in a young, non-diabetic patient on dialysis for a short time. We confirmed the role of bone turnover disorders in the pathogenesis of EC, where the rapid progression of secondary hyperparathyroidism was a determinant of the patient's clinical manifestations. We emphasize the interrelation of bone and vessel, demonstrated by the severe loss of bone mass and the intensity of the EC. Nephrologists must understand the consequences of the mineral and bone disorder of CKD, so that interventions are early, in order to avoid very serious cases such as the one reported herein.