Reversal of uremic tumoral calcinosis by optimization of clinical treatment of bone and mineral metabolism disorder

Abstract

Tumoral calcinosis is an uncommon type of extraosseous calcification characterized by large rubbery or cystic masses containing calcium-phosphate deposits. The condition prevails in the periarticular tissue with preservation of osteoarticular structures. Elevated calcium-phosphorus products and severe secondary hyperparathyroidism are present in most patients with uremic tumoral calcionosis (UTC). Case report of an obese secondary to chronic glomerulonephritis, undergoing continuous ambulatory peritoneal dialysis (CAPD) reported the appearance of painless tumors in the medial surface of fifth finger and left arm. Tumoral calcinosis was confirmed by left biceps biopsy. Poor adherence to CAPD. The patient was transferred to the "tidal" modality of peritoneal dialysis and after was treated by hemodialysis, despite the persistence of severe hyperparathyroidism progressive reduction of UTC until near to its complete disappearance. Nowadays, one year after patient received deceased-donor kidney transplantation, he presents with an improvement in secondary hyperparathyroidism. UTC should be included in the elucidation of periarticular calcification of every patient on dialysis. Relevant laboratory findings such as secondary hyperparathyroidism and elevated calcium- phosphorus products in the presence of periarticular calcification should draw attention to the diagnosis of UTC.

Complete Resolution of Tumoral Calcinosis in a Patient on Peritoneal Dialysis with Cinacalcet

“…There is no definite treatment of tumoral calcinosis (TC). Medical therapy alone and parathyroidectomy appear to be disappointing, with the complications of postoperative hungry bone disease occurring in the latter (1,2). Cinacalcet is a calcimimetic drug indicated for the treatment of secondary hyperparathyroidism in patients with end-stage kidney disease (ESKD).…”

Massive soft tissue calcifications in a patient with end stage renal disease, complete resolved by Cinacalcet. A case report and review.

“…Current treatments consist of dietary phosphorus restriction, oral administration of intestinal phosphate binders, oral or intravenous calcitriol, oral calcimimetic agents (cinacalcet), and intensive hemodialysis with low calcium dialysate. Surgical excision of tumoral calcinosis, parathyroidectomy, and kidney transplantation are recommended for persistent or refractory cases [1,2]. Here we report a patient with ESRD complicated by metastatic calcification.…”

“…Elevated levels of calcium-phosphorus products and severe secondary hyperparathyroidism are present in these patients. Common sites of involvement include blood vessels, the periarticular region, heart, lungs, kidneys, gastric mucosa, central nervous system, breasts, and eyes [1]. Secondary hyperparathyroidism is an important complication of chronic kidney disease (CKD) and end stage renal disease (ESRD).…”