Cofan F, García S, Combalia A, Campistol J M, Oppenheimer F, Ramón R
Orthopedic Department, Hospital Clinic, University of Barcelona, Spain.
J Rheumatol. 1999 Feb;26(2):379-85.
To analyze a series of uremic tumoral calcinosis (UTC) in patients receiving longterm dialysis therapy.
Twelve patients receiving longterm hemodialysis affected by tumoral calcinosis were analyzed. Clinical, radiological, and pathological features were evaluated and pathogenic factors were reviewed.
The most common sites for UTC were the elbow, hip, hand, and wrist. The lesions were multiple (67%, n = 8), of large size, and symptomatic with joint mobility impairment (75%, n = 9) as well as nerve compression (33%, n = 4). High serum calcium and phosphate concentrations were detected in 50% (n = 6) and 100% of the patients, respectively. An increased calcium-phosphorus product (Ca x P) was observed in all patients, either due to overt secondary hyperparathyroidism (42%, n = 5), or secondary to iatrogenic hypercalcemia and/or severe hyperphosphoremia of multifactorial etiology (i.e., prolonged and excessive administration of calcitriol and calcium carbonate, insufficient dialysis and inadequate phosphorus chelating therapy, etc.) (58%, n = 7). Several treatment strategies were followed (surgical excision, parathyroidectomy, renal transplant) in combination with aggressive medical therapy to decrease Ca x P product, achieving complete remission in 83% of the patients.
UTC lesions show clinical and pathogenic features that differ from those of idiopathic tumoral calcinosis. The most important pathogenic factor involved in UTC is an increase in Ca x P, not necessarily related to hyperparathyroidism. Combined treatment strategies allow complete remission in a high proportion of patients. A low Ca x P is necessary to prevent development of UTC.
分析接受长期透析治疗的一系列尿毒症性肿瘤性钙化（UTC）患者。
对12例接受长期血液透析且患有肿瘤性钙化的患者进行分析。评估临床、放射学和病理学特征，并回顾致病因素。
UTC最常见的部位是肘部、髋部、手部和腕部。病变为多发（67%，n = 8），体积较大，有症状，表现为关节活动受限（75%，n = 9）以及神经受压（33%，n = 4）。分别在50%（n = 6）和100%的患者中检测到高血清钙和磷浓度。所有患者均观察到钙磷乘积（Ca×P）升高，这要么是由于明显的继发性甲状旁腺功能亢进（42%，n = 5），要么是继发于医源性高钙血症和/或多因素病因导致的严重高磷血症（即骨化三醇和碳酸钙的长期过量给药、透析不足和磷螯合治疗不充分等）（58%，n = 7）。采取了多种治疗策略（手术切除、甲状旁腺切除术、肾移植）并联合积极的药物治疗以降低Ca×P乘积，83%的患者实现了完全缓解。
UTC病变显示出与特发性肿瘤性钙化不同的临床和致病特征。UTC中最重要的致病因素是Ca×P升高，不一定与甲状旁腺功能亢进有关。联合治疗策略可使高比例患者实现完全缓解。低Ca×P对于预防UTC的发生是必要的。
