Severe ectopic calcification of the intestinal wall in a patient on long-term continuous ambulatory peritoneal dialysis therapy

Ubara, Yoshifumi; Katori, Hideyuki; Tagami, Tetsuo; Yokota, Masafumi; Kitamura, Akiko; Matsushita, Yoshio; Imai, Takeshi; Inoue, Sumio; Kuzuhara, K; Yamada, Akira; Takagawa, Ryuko

doi:10.1016/s0272-6386(00)70027-8

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…In most CAPD patients with peritoneal calcification reported so far, abdominal CT scans show sheet‐like calcification surrounding the bowel (1–4,6,9,10,12–14). Some of these patients have extensive calcification in both visceral and parietal peritoneum (1,4) or on the liver surface (15,16).…”

Section: Discussionmentioning

confidence: 99%

“…This indicates that the unique conditions of CAPD, such as persistent stimulation of the peritoneum with hyperosmolar dialysates and acetate buffer, recurrent peritonitis and dispersion of ferric ions from bloody dialysate into the abdominal cavity may stimulate calcium deposition. Secondary hyperparathyroidism in cases 1 and 2, and long‐term vitamin D treatment in Case 3, might have facilitated calcium deposits caused by the unique circumstances incurred by CAPD (3–5,9).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, once peritoneal calcification is detected, it is essential to assess whether EPS develops. However, in some patients on CAPD, peritoneal calcification is not accompanied by EPS with intractable intestinal obstruction (1–5); and even if complicated abdominal symptoms develop, they improve readily by shifting to hemodialysis or using tidal peritoneal dialysis (6). Thus there is a possibility that CAPD patients with peritoneal calcification show different abdominal signs and clinical symptoms related to the characteristics of peritoneal calcification.…”

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confidence: 99%

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Localization and Extent of Peritoneal Calcification in Three Uremic Patients on Continuous Ambulatory Peritoneal Dialysis

et al. 2008

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Peritoneal calcification in three patients on continuous ambulatory peritoneal dialysis (CAPD) was reviewed, and the relation between the localization and extent of calcium deposits detected by abdominal computed tomography (CT) and clinical signs was evaluated. Case 1 was a 48-year-old man with abdominal pain, hemoperitoneum and secondary hyperparathyroidism after receiving CAPD for seven years. An abdominal CT revealed linear peritoneal calcification in the pelvic cavity and liver surface, and his symptoms resolved after switching to hemodialysis. His clinical course and pathological findings were compatible with those in progressive calcifying peritonitis. Case 2 was a 26-year-old man presenting with abdominal pain, vomiting and fullness two years after switching to hemodialysis, because of uncontrolled overhydration following 13 years of CAPD. Plaque-like calcification outlining the small intestine and parietal peritoneum was noted on CT. Case 3 was a 59-year-old man who had abdominal distention, vomiting and diarrhea three months after switching to hemodialysis due to loss of peritoneal function following 10 years of CAPD. CT revealed diffuse sheet-like calcification surrounding the bowel and mesentery, adherent dilated bowel loops and ascites. These CT findings suggested the existence of encapsulating peritoneal sclerosis (EPS) in cases 2 and 3. Findings from our three patients indicate that peritoneal calcification is not always accompanied by EPS; however, monitoring peritoneal calcification and other findings by abdominal CT, even after cessation of CAPD, is crucial to maintain vigilance on whether the subclinical signs, which are temporally diagnosed as progressive calcifying peritonitis, advance to EPS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Localization and Extent of Peritoneal Calcification in Three Uremic Patients on Continuous Ambulatory Peritoneal Dialysis

et al. 2008

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“…Although calcium deposition is the major factor of PC, whether dysregulation of calcium-phosphate metabolism is a key factor in the pathogenesis of PD-related PC remains controversial [2], [3], [4], [5]. On the other hand, in hemodialysis (HD) patients, who commonly have mineral and bone disorders, PC is seldom detected.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a lack of a large study aimed at defining the risk factors of PC. Several case reports proposed possible links between PC and PD, including calcium from dialysate [7], repeated peritonitis [2], [8], calciphylaxis [9], and hypertonic dialysate [10]. These are all local factors in the peritoneal cavity.…”

Section: Introductionmentioning

confidence: 99%

High Peritoneal KT/V and Peritonitis Rates Are Associated with Peritoneal Calcification

et al. 2013

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BackgroundPeritoneal calcification (PC) is a specific finding in patients undergoing peritoneal dialysis (PD), but its prevalence, risk factors, and impacts in PD patients remain unclear. The present study investigated these issues and provided information useful for the management of PC.MethodsThe study included 183 PD patients. The severity of PC was determined using abdominal computed tomography (CT), and we summed up all scores from slices obtained from the diaphragm to the pelvic floor normalized to body surface area. We analyzed the associations between PC and demographic and clinical characteristics, and between PC and levels of biomarkers, including C-reactive protein (CRP), osteoprotegrin and fetuin-A. The determinants of PC were examined using multiple regression analysis.ResultsPatients were categorized into group 1 (without PC, n = 133) and group 2 (with PC, n = 50). Group 2 patients showed different degrees of PC with a mean of 160±769 mm2/m2. Group 1 patients had higher fetuin-A levels than group 2 patients (861±309 vs. 760±210 µg/mL; p = 0.021). The independent risk factors for the presence of PC included male gender, previous peritonitis, and PD adequacy (KT/V). Further analysis performed in group 2 patients showed that the dosage of vitamin D, serum levels of CRP, and dialysate calcium load were the independent determinants of PC. However, the presence of PC did not affect patients’ technique survival, peritonitis incidence, or mortality in the mean follow up period of 28±12 months.ConclusionsThe presence and severity of PC were associated with inflammation, peritoneal KT/V, and mineral metabolism. The impact of PC on the outcomes of PD patients requires further study with a longer follow-up.

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H

Lachman¹

2007

Taybi and Lachman's Radiology of Syndromes, Metabolic Disorders and Skeletal Dysplasias

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Severe ectopic calcification of the intestinal wall in a patient on long-term continuous ambulatory peritoneal dialysis therapy

Cited by 9 publications

References 10 publications

Localization and Extent of Peritoneal Calcification in Three Uremic Patients on Continuous Ambulatory Peritoneal Dialysis

Localization and Extent of Peritoneal Calcification in Three Uremic Patients on Continuous Ambulatory Peritoneal Dialysis

High Peritoneal KT/V and Peritonitis Rates Are Associated with Peritoneal Calcification

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