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Kidney Week

Abstract: TH-PO341

Tumoral Calcinosis in a Patient with ESKD on Peritoneal Dialysis: A Diagnostic Dilemma

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Kalra, Kartik, Geisinger Health, Danville, Pennsylvania, United States
  • Sankar, Lakshna, Geisinger Health, Danville, Pennsylvania, United States
  • Norfolk, Evan, Geisinger Health, Danville, Pennsylvania, United States
Introduction

Tumoral calcinosis is an uncommon complication of secondary hyperparathyroidism related to end-stage kidney disease (ESKD) with calcium and phosphate deposition in soft tissues, which is different from calciphylaxis characterized by microvascular calcification resulting in painful skin ulcers.

Case Description

A 42-year-old woman with history of ESKD on peritoneal dialysis (PD) for 6 years presented with severe multiple joint pains for 2-week duration. Home medications included losartan, cinacalcet and calcium acetate. Labs revealed phosphorus of 11 mg/dl (2.5 - 4.8 mg/dl); parathyroid hormone (PTH) of 1061 pg/ml (15-65 pg/ml). She was anuric and her most recent Kt/V was 2.3. On examination, she had tenderness in multiple proximal and distal interphalangeal joints on her hands, bilateral hip, and knee joints. Computed tomography (CT) pelvis with contrast showed calcified masses in soft tissue and periarticular region in bilateral hip consistent with tumoral calcinosis (Figure A, B and C – red arrows); direct extrinsic erosion of the right posterior proximal femoral diaphyseal cortex (Figure C – yellow arrow) and left hip acetabulum. Given the severity of symptoms, she was transitioned to intermittent hemodialysis and received sodium thiosulfate infusions. Calcium acetate was switched to sevalamer. She received a kidney transplant 3 months later. On 10 month follow up, her symptoms resolved.

Discussion

The timeline for tumoral calcinosis can range from 17 - 84 months in PD patients. Treatment includes low phosphorus diet, noncalcium-based phosphorus binders, calcimimetics, sodium thiosulfate and surgical options are parathyroidectomy for secondary or tertiary hyperparathyroidism. Nephrologists should be aware of this rare entity to provide appropriate care including patient education on medication adherence, if needed switching dialysis modalities to intensive hemodialysis (5 times per week) and surgical management. Studies have shown complete resolution of tumoral calcinosis after kidney transplant.