UREMIC TUMOR CALCINOSIS: A PROBLEM STILL PRESENT TODAY

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E-Poster

https://storage.unitedwebnetwork.com/files/1099/85ce58ebe191d085a7d3fe8c47eaa04e.pdf

Abstract Title

First Name *

Gustavo

Last Name *

Gomes Thomé

Co-author 1

Gabriela Vieira Steckert gsteckert@hcpa.edu.br Hospital de Clínicas de Porto Alegre Nephrology Porto Alegre

Co-author 2

Gabriela Moreira Ferle gmferle@hcpa.edu.br Hospital de Clínicas de Porto Alegre Nephrology Porto Alegre

Co-author 3

Renata Asnis Schuchmann rschuchmann@hcpa.edu.br Hospital de Clínicas de Porto Alegre Nephrology Porto Alegre

Co-author 4

Gabriel Sartori Pacini gpacini@hcpa.edu.br Hospital de Clínicas de Porto Alegre Nephrology Porto Alegre

Co-author 5

Suzane Cristina Milech Pribbernow spribbernow@hcpa.edu.br Hospital de Clínicas de Porto Alegre Nephrology Porto Alegre

Co-author 6

Cristina Karohl ckarohl@hcpa.edu.br Hospital de Clínicas de Porto Alegre Nephrology Porto Alegre

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Secondary Hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). Uremic tumoral calcinosis is an uncommon consequence of severe SHPT that can lead to deformitis and severe life impairment. Although nowadays this is a rare complication, it still can be found, especially in places where patients have low access to SHPT treatment options.

Methods

The objective of this work is to describe a case of advanced SHPT with findings of tumoral calcinosis and metastatic pulmonary calcifications.

Results

A male patient, 36 years old, with a history of CKD of unknown etiology, who has been on hemodialysis since 2007, was referred to evaluate a tumor in the lower back and fingers of both hands. On physical examination, the patient presented calcified nodules on the 1st and 3rd fingers of the right hand and 1st and 2nd fingers of the left hand with whitish discharge, in addition to an extensive tumoral lesion in the sacral region with a stone consistency. The chest radiography (X-ray) identified grossly nodular opacities with calcifications at the apex of the left lung and the chest Computed Tomography (CT) corroborated the X-ray findings, revealing that the pulmonary metastatic calcifications were amid normal lung tissue. The hand X-ray described findings of extensive vascular calcifications with uremic tumor calcinosis and the lumbar spine CT showed a sacral soft tissue lesion measuring 13.2 x 11.1 x 5.3 cm, compatible with uremic tumor calcinosis. Laboratory tests demonstrated: parathyroid hormone levels of 2364 pg/mL; calcium of 9.3 mg/dL; phosphorus of 11.4 mg/dL; alkaline phosphatase of 413 U/L; and calcium-phosphorus product of 106 mg²/dl². Parathyroid scintigraphy highlighted an area of greater radiotracer uptake located in the lower third of the left lobe. The echocardiogram showed fibrocalcific degeneration of the aortic valve, without associated valve dysfunction. The patient was referred for subtotal parathyroidectomy.

Conclusions

Metastatic calcifications and uremic tumor calcinosis, although uncommon, are serious manifestations of prolonged SHPT, which can cause deformities and reduce the patient's quality of life. Early identification and management of bone metabolism disorders must be carried out in patients with CKD to avoid such serious complications.

This case was also presented in the XXII Congresso Paulista de Nefrologia, and re-submiting it is permitted by the organizers of the event.

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