The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Blood Purif. 2020;49(6):658-664. doi: 10.1159/000506115. Epub 2020 Apr 14.
BACKGROUND/AIMS: Uremic tumoral calcinosis (UTC) is a rare disease with metastatic tissue calcification in maintenance hemodialysis (HD) patients. However, limited data are available on the treatment of UTC in HD patients. This article mainly discusses the diagnostic findings and efficacy of treatment on HD patients with UTC.
A retrospective analysis was conducted based on the data of 13 cases of UTC, including their clinical features, biochemical indicators, imaging findings, diagnosis, therapeutic methods, and follow-up results. Parathyroidectomy (PTX) or drug treatment was determined based on intact parathyroid hormone (iPTH) levels and clinical symptoms.
All 13 patients were diagnosed as UTC definitely by imaging examination. The predominant areas involved were the buttocks (4 cases, 30.77%), shoulders (4 cases, 30.77%), and elbows (3 cases, 23.08%). Based on the levels of iPTH, cases were categorized into 2 different groups: PTX treatment group was associated with high levels of iPTH, while drug treatment group (lanthanum carbonate or sevelamer with sodium thiosulfate) was associated with lower iPTH levels. After PTX treatment, there was a significant decrease in serum iPTH, calcium (Ca), phosphate (P), and alkaline phosphatase levels (p < 0.05). In drug treatment group, the serum p levels were decreased significantly, along with a finding that hemoglobin levels were increased (p < 0.05). All the UTC had lessened or even disappeared after 4-6 months treatment.
Although most UTC patients have an increased iPTH, a small number had lower iPTH levels. Based on iPTH levels and clinical symptoms, the patients were treated with PTX or drug therapy. With proper treatment, UTC disappeared without the need for surgery to remove calcinosis tissue.
背景/目的：尿毒症性肿瘤性钙化（UTC）是一种罕见疾病，其特征为维持性血液透析（HD）患者的转移性组织钙化。然而，目前关于 HD 患者 UTC 的治疗数据有限。本文主要讨论了 HD 患者 UTC 的诊断发现和治疗效果。
对 13 例 UTC 患者的数据进行回顾性分析，包括其临床特征、生化指标、影像学发现、诊断、治疗方法和随访结果。根据全段甲状旁腺激素（iPTH）水平和临床症状确定甲状旁腺切除术（PTX）或药物治疗。
所有 13 例患者均通过影像学检查明确诊断为 UTC。主要受累部位为臀部（4 例，30.77%）、肩部（4 例，30.77%）和肘部（3 例，23.08%）。根据 iPTH 水平，病例分为 2 个不同组：PTX 治疗组与高 iPTH 相关，而药物治疗组（碳酸镧或硫代硫酸钠与司维拉姆）与较低 iPTH 水平相关。PTX 治疗后，血清 iPTH、钙（Ca）、磷（P）和碱性磷酸酶水平显著降低（p<0.05）。在药物治疗组中，血清 p 水平显著降低，同时发现血红蛋白水平升高（p<0.05）。所有 UTC 经 4-6 个月治疗后均减轻或消失。
尽管大多数 UTC 患者的 iPTH 升高，但少数患者的 iPTH 水平较低。根据 iPTH 水平和临床症状，对患者进行 PTX 或药物治疗。经过适当的治疗，UTC 消失，无需手术切除钙化组织。
