Corneal and Conjunctival Calcification in a Dialysis Patient Reversed by Parathyroidectomy

Pessoa, Maria Beatriz C N; Santo, Ruth Miyuki; Deus, Aline Alves De; Duque, Eduardo Jorge; Rochitte, Carlos Eduardo; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

doi:10.1159/000508804

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…Our result suggests a different physiopathology of both calcification sites, coronary and eyes. In this way, we previously demonstrated an improvement in CCC after parathyroidectomy, (16) whereas coronary artery calcification seems to be a more complicated site to recover from calcification. (17) Hyperphosphatemia was identified as a risk factor for corneal and conjunctival calcification.…”

Section: Discussionmentioning

confidence: 77%

Corneal and Coronary Calcification in Maintenance Hemodialysis: The Face Is No Index to the Heart

Pessoa,

Santo,

de Deus

et al. 2023

JBMR Plus

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Although the eyes are the main site of metastatic calcification in patients with chronic kidney disease (CKD), corneal and conjunctival calcification (CCC) is poorly evaluated in this population. Whether CCC correlates with coronary artery calcification remains unknown since studies so far have relied on methods with low sensitivity. Our objective was to test the relationship between CCC and coronary calcification based on tomography. This was a cross‐sectional study that included patients on maintenance dialysis. Clinical, demographic, and biochemical data (calcium, phosphorus, parathormone, alkaline phosphatase, and 25(OH)‐vitamin D) were recorded. Hyperparathyroidism was defined as parathyroid hormone (PTH) > 300 pg/mL. CCC was evaluated by anterior segment optical coherence tomography (AS‐OCT), and coronary calcium scores (Agatston method) were assessed by computed tomography. We compared no/mild with moderate/severe CCC. Twenty‐nine patients were included (49.6 ± 15.0 years, 62.1% female, on hemodialysis for 5.7 [2.7–9.4] years, 17.2% with diabetes mellitus, 75.9% with hyperparathyroidism). CCC was found in 82.7% of patients, with median scores of 9 (3, 14.5), ranging from 0 to 16. CCC was classified as absent/mild, moderate, and severe in 27.6%, 20.7%, and 51.7%, respectively. Coronary calcification was found in 44.8% of patients, with median scores of 11 (0, 464), varying from 0 and 6456. We found no significant correlation between coronary calcium scores and CCC (r = 0.203, p = 0.282). Hyperphosphatemia was more frequent in patients with moderate/severe CCC than in those with absent/mild CCC. We concluded that CCC was frequent in patients with CKD on dialysis and did not correlate with coronary calcium scores. Hyperphosphatemia appears to contribute to CCC. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 77%

Corneal and Coronary Calcification in Maintenance Hemodialysis: The Face Is No Index to the Heart

Pessoa,

Santo,

de Deus

et al. 2023

JBMR Plus

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“…Hypercalcaemia, hyperphosphataemia and secondary hyperparathyroidism all contribute to the development of metastatic calci cation. Parathyroidectomy is an important treatment for SHPT, and studies have shown that hyperparathyroidism surgery improves metastatic calci cation in a variety of sites (corneoconjunctival, subcutaneous and mammary calci cation) [31][32][33][34] . Low iPTH levels have also been found to be a predictor of mortality in patients on HD and PD [35] .…”

Section: Resultsmentioning

confidence: 99%

Clinical characteristics and prognosis of dialysis patients with metastatic calcification diagnosed by 99mTc-MDP bone scintigraphy

Wang,

Xiao

et al. 2024

Preprint

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Objective: To analyse the clinical characteristics of patients with metastatic calcification combined with maintenance dialysis. Methods: Patients diagnosed with metastatic calcification by 99mTc-MDP bone scintigraphy from June 2019 to March 2023 in our hospital. All patients were followed from the diagnosis until death, loss to follow-up, or study endpoint time (2023.07). The primary endpoint observational event was all-cause mortality. Results: There were 7 males and 3 females with an mean age of (49.2±10.6) years. The most common sites of metastatic calcification were lungs, joints, and skin, other rare sites were stomach, myocardium, and mandibular angle. 9 patients were treated with sodium thiosulfate(STS) and the mean duration medication of STS was 23.5(13.25，56.5) days. The mean follow-up time was 14(10,20) months, 1 case died, 1 case was loss to follow-up, 8(8/10) cases survived, and 6(6/10) cases were followed for more than 1 year. Conclusion: 99mTc-MDP bone scintigraphy has a high sensitivity and specificity for metastatic calcification, and the most common sites of metastatic calcification are lungs, joints, and skin, while the other rare sites are stomach, myocardium, and mandibular angle.8 patients (8/10) survived, and 6 patients (6/10) were alive with more than 1 year of follow-up.

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“…Additionally, a 2008 case report suggested that SHPT plays a critical role in the pathogenesis of tumor calcinosis in patients on hemodialysis[ 9 ]. Pessoa et al [ 10 ] reported the recovery of a patient with conjunctival and corneal calcification after PTX. In this case, the CAVB was caused by metastatic calcification of the heart, including metastatic calcification of the left atrium, left ventricle and mitral valve.…”

Section: Discussionmentioning

confidence: 99%

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report

Xu,

Hao,

Guan

2024

World J Clin Cases

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BACKGROUND Refractory secondary hyperparathyroidism (SHPT) is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification. Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias, including atrioventricular block. This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block (CAVB), which was eventually reversed to a first-degree atrioventricular block. CASE SUMMARY We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy. She developed SHPT, and an electrocardiogram revealed a first-degree atrioventricular block. Then, she underwent parathyroidectomy (PTX) with autotransplantation. Unfortunately, a few years later, she developed SHPT again, and an electrocardiogram revealed a CAVB. A few years after the second PTX surgery, the calcification of the left atrium and left ventricle improved, and her CAVB was reversed. CONCLUSION This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage. Following parathyroid surgery, calcification of the cardiac conduction system improved, leading to reversal of the atrioventricular block. It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

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Corneal and Conjunctival Calcification in a Dialysis Patient Reversed by Parathyroidectomy

Cited by 6 publications

References 2 publications

Corneal and Coronary Calcification in Maintenance Hemodialysis: The Face Is No Index to the Heart

Corneal and Coronary Calcification in Maintenance Hemodialysis: The Face Is No Index to the Heart

Clinical characteristics and prognosis of dialysis patients with metastatic calcification diagnosed by 99mTc-MDP bone scintigraphy

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report

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