Soft tissue calcification in pediatric patients with end-stage renal disease

Abstract

Soft tissue calcification is a recognized complication of uremia in adult patients and has been implicated as a cause of ischemic necrosis, cardiac arrhythmias, and respiratory failure. However, soft tissue calcification has been regarded as rare in pediatric renal patients. Following a sudden death due to pulmonary calcinosis in an adolescent after renal transplantation, we retrospectively reviewed clinical, biochemical and autopsy data of 120 patients with uremia, on dialysis, or following renal transplantation cared for at Childrens Hospital of Los Angeles from 1960 to 1983. Soft tissue calcification was found in 72 of 120 patients (60 percent). Forty-three patients (36 percent) had systemic calcinosis (Group A): the most frequent sites of mineral deposition were blood vessels, lung, kidney, myocardium, coronary artery, central nervous system, and gastric mucosa. Vascular calcification was uniformly accompanied by deposits in other organs. Twenty-nine patients had small amounts of focal calcification (Group B) and 48 patients had no soft tissue calcification (Group C). By multiple logistic regression analysis, the use of vitamin D or its analogues, the form of vitamin D medication prescribed, the peak calcium x phosphorus product, the age at onset of renal failure, and male sex were jointly associated with calcinosis (Group A). Vitamin D therapy showed the strongest independent association with calcinosis and the probability of calcinosis was greater in patients receiving calcitriol when compared with dihydrotachysterol and vitamin D2 or D3. The duration of renal failure, peak serum calcium, serum calcium at death, serum phosphorus at death, and primary renal diagnosis, were not statistically associated with calcinosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Mineral Metabolism and Vascular Damage in Children on Dialysis

“…Although the prescribed dosage of vitamin D is also a surrogate marker of the severity of hyperparathyroidism, the vitamin D dosage predicted vascular damage independent of iPTH levels. The role of vitamin D in the pathogenesis of vascular calcification has been shown in other observational studies 4,5 as well as in ex vivo 34 and in vitro models. 35 Although the primary role of vitamin D is to increase the gastrointestinal absorption of calcium, it also significantly increases PO 4 absorption.…”

Influence of Biochemical Alterations on Arterial Stiffness in Patients With End-stage Renal Disease

“…28 They are often considered a consequence of an increased calcium phosphate product, in association with secondary hyperparathyroidism or adynamic bone disease. 29 On the other hand, diabetes is known to be frequently associated with ESRD. 30 Diabetic patients with advanced renal failure have a mediocre vascular prognosis, related in particular to macroangiopathies and increased arterial stiffness.…”

Reducing the Burden of Cardiovascular Calcification in Patients with Chronic Kidney Disease

“…Rats that were treated with high-dose vitamin D developed calcification in the aorta, carotid, hepatic, mesenteric, renal, and femoral arteries (26). Clinical studies have also reported an association between vascular calcification and use of vitamin D therapy in hyperphosphatemic patients with renal failure (27,28). Vascular smooth muscle cells (VSMC) have been shown to express vitamin D receptors (29).…”