Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4004
Peer-review started: August 20, 2019
First decision: September 23, 2019
Revised: October 6, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: December 6, 2019
One of the common late sequela in patients with end-stage renal disease (ESRD) is the calcium phosphate disorder leading to chronic hypercalcemia and hyperphosphatemia causing the precipitation of calcium salt in soft tissues. Tumoral calcinosis is an extremely rare clinical manifestation of cyst-like soft tissue deposits in different periarticular regions in patients with ESRD and is characterized by extensive calcium salt containing space-consuming painful lesions. The treatment of ESRD patients with tumoral calcinosis manifestation involves an increase in or switching of renal replacement therapy regimes and the adjustment of oral medication with the goal of improved hypercalcemia and hyperphosphatemia.
We describe a 40-year-old woman with ESRD secondary to IgA-nephritis and severe bilateral manifestation of tumoral calcinosis associated with hypercalcemia, hyperphosphatemia and tertiary hyperparathyroidism. The patient was on continuous ambulatory peritoneal dialysis and treatment with vitamin D analogues. After switching her to a daily hemodialysis schedule and adjusting the medical treatment, the patient experienced a significant dissolution of her soft tissue calcifications within a couple of weeks. Complete remission was achieved 11 mo after the initial diagnosis.
Reduced patient compliance and subsequent insufficiency of dialysis regime quality contribute to the aggravation of calcium phosphate disorder in a patient with ESRD leading to the manifestation of tumoral calcinosis. However, the improvement of the treatment strategy and reinforcement of patient compliance enabled complete remission of this rare disease entity.
Core tip: Tumoral calcinosis, a very rare disease entity, occurred in the described patient with end-stage renal disease due to disturbed calcium phosphate metabolism and insufficient quality of continuous ambulatory peritoneal dialysis. Complete remission was achieved by modification of the medical treatment and by switching to hemodialysis, which improved the dialysis quality. In general, to recuperate severe tumoral calcinosis, the treatment must be selected based on an understanding of the clinical background and the quality of the renal replacement therapy regime. In conclusion, this case report will significantly contribute to the reader’s understanding of tumoral calcinosis pathogenesis and treatment in patients with end-stage renal disease.