Westermann Lukas, Isbell Lisa K, Breitenfeldt Marie K, Arnold Frederic, Röthele Elvira, Schneider Johanna, Widmeier Eugen
Department of Medicine IV, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany.
Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany.
World J Clin Cases. 2019 Dec 6;7(23):4004-4010. doi: 10.12998/wjcc.v7.i23.4004.
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.
终末期肾病（ESRD）患者常见的晚期后遗症之一是钙磷紊乱，导致慢性高钙血症和高磷血症，进而使钙盐在软组织中沉淀。肿瘤性钙化是ESRD患者在不同关节周围区域出现的类似囊肿的软组织沉积物的一种极其罕见的临床表现，其特征是含有大量钙盐的、占据空间且引起疼痛的病变。对有肿瘤性钙化表现的ESRD患者的治疗包括增加或更换肾脏替代治疗方案以及调整口服药物，目的是改善高钙血症和高磷血症。
我们描述了一名40岁女性，患有IgA肾病继发的ESRD，伴有严重的双侧肿瘤性钙化表现，同时伴有高钙血症、高磷血症和三发性甲状旁腺功能亢进。该患者接受持续非卧床腹膜透析，并使用维生素D类似物进行治疗。在将她改为每日血液透析方案并调整治疗后，患者在几周内软组织钙化明显溶解。初次诊断11个月后实现了完全缓解。
患者依从性降低以及随后透析方案质量不足导致ESRD患者钙磷紊乱加重，进而出现肿瘤性钙化表现。然而，治疗策略的改进和患者依从性的加强使这种罕见疾病实体完全缓解。
