Different Outcomes Following Parathyroidectomy in Patients with Uremic Tumoral Calcinosis: Two Case Reports

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2023 Mar 16

PMID 36922797

Authors

Jialin Li

Xuan Li

Xiuhong Dong

Lin Ma

Zhentao Guo

Xuexun Chen

Affiliations

Soon will be listed here.

Abstract

Background: Uremic tumoral calcinosis (UTC) is a rare complication in hemodialysis patients, whose mechanism remains incompletely understood. We report two cases with UTC who experienced completely different patterns of regression following parathyroidectomy, although there were no significant differences in serum calcium levels, parathyroid hormone, or phosphorus production between the two patients.

Case Presentation: Case 1 had a substantial improvement in soft tissue calcification. However, in Case 2, one calcified mass was partially absorbed, while the others were aggravated with severe microvascular calcification and subcutaneous extravascular calcification. Whole-exome sequencing data revealed five mutation sites associated with atherosclerosis.

Conclusion: The different outcomes in UTC patients after PTX are rare. Further studies are required to elucidate the mechanism of paradoxical changes occurring in patients with UTC after parathyroidectomy.

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References

Gao Z, Li X, Miao J, Lun L . Impacts of parathyroidectomy on calcium and phosphorus metabolism disorder, arterial calcification and arterial stiffness in haemodialysis patients. Asian J Surg. 2018; 42(1):6-10. DOI: 10.1016/j.asjsur.2018.04.001. View

Olsen K, Chew F . Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006; 26(3):871-85. DOI: 10.1148/rg.263055099. View

Sunder S, Verma H, Venkataramanan K . Cervical tumoral calcinosis with secondary hyperparathyroidism in a chronic hemodialysis patient. Hemodial Int. 2012; 17(3):458-62. DOI: 10.1111/j.1542-4758.2012.00760.x. View

Kanehisa M, Furumichi M, Sato Y, Kawashima M, Ishiguro-Watanabe M . KEGG for taxonomy-based analysis of pathways and genomes. Nucleic Acids Res. 2022; 51(D1):D587-D592. PMC: 9825424. DOI: 10.1093/nar/gkac963. View

Pasch A . Bone mass gain after parathyroidectomy. Kidney Int. 2008; 74(6):697-9. DOI: 10.1038/ki.2008.321. View

Kim Y, Hwang E, Park S . Resolution of uremic tumoral calcinosis in a patient on peritoneal dialysis with long-term low-calcium dialysate treatment. Kidney Res Clin Pract. 2016; 33(4):226-8. PMC: 4714287. DOI: 10.1016/j.krcp.2014.09.002. View

Neto R, Pereira L, Magalhaes J, Quelhas-Santos J, Frazao J . Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients. PLoS One. 2021; 16(10):e0258284. PMC: 8513829. DOI: 10.1371/journal.pone.0258284. View

Rodriguez-Ortiz M, Pendon-Ruiz de Mier M, Rodriguez M . Parathyroidectomy in dialysis patients: Indications, methods, and consequences. Semin Dial. 2019; 32(5):444-451. DOI: 10.1111/sdi.12772. View

London G, Marty C, Marchais S, Guerin A, Metivier F, de Vernejoul M . Arterial calcifications and bone histomorphometry in end-stage renal disease. J Am Soc Nephrol. 2004; 15(7):1943-51. DOI: 10.1097/01.asn.0000129337.50739.48. View

10.

Niemann K, Kropil F, Hoffmann M, Coulibaly M, Schildhauer T . A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report. Int J Surg Case Rep. 2016; 23:56-60. PMC: 4855743. DOI: 10.1016/j.ijscr.2016.04.011. View

11.

Kanehisa M, Goto S . KEGG: kyoto encyclopedia of genes and genomes. Nucleic Acids Res. 1999; 28(1):27-30. PMC: 102409. DOI: 10.1093/nar/28.1.27. View

12.

Ke G, Li S, Cui Y, Chen X, Che H, Dou C . Treatment of Uremic Tumoral Calcinosis in Maintenance Hemodialysis Patients. Blood Purif. 2020; 49(6):658-664. DOI: 10.1159/000506115. View

13.

Kakani E, Sloan D, Sawaya B, El-Husseini A, Malluche H, Rao M . Long-term outcomes and management considerations after parathyroidectomy in the dialysis patient. Semin Dial. 2019; 32(6):541-552. DOI: 10.1111/sdi.12833. View

14.

Sabeel A, Al-Homrany M . Complete resorption of massive soft tissue calcification in a hemodialysis patient after parathyroidectomy. Am J Nephrol. 2000; 20(5):421-4. DOI: 10.1159/000013630. View

15.

Fathi I, Sakr M . Review of tumoral calcinosis: A rare clinico-pathological entity. World J Clin Cases. 2014; 2(9):409-14. PMC: 4163761. DOI: 10.12998/wjcc.v2.i9.409. View

16.

Yang P, Troncone L, Augur Z, Kim S, McNeil M, Yu P . The role of bone morphogenetic protein signaling in vascular calcification. Bone. 2020; 141:115542. PMC: 8185454. DOI: 10.1016/j.bone.2020.115542. View

17.

Xiong M, Wang J, Li X, Yu Y, Zhang L . [Clinical characteristics of 10 patients with uremic tumoral calcinosis]. Zhonghua Nei Ke Za Zhi. 2020; 59(11):860-865. DOI: 10.3760/cma.j.cn112138-20200305-00193. View

18.

Younes M, Belghali S, Zrour-Hassen S, Bejia I, Touzi M, Bergaoui N . Complete reversal of tumoral calcinosis after subtotal parathyroidectomy in a hemodialysis patient. Joint Bone Spine. 2008; 75(5):606-9. DOI: 10.1016/j.jbspin.2007.08.012. View

19.

Shen X, Chen W, Wang X, Chen J . Uremic tumoral calcinosis in a patient on hemodialysis. Intern Med. 2012; 51(11):1443. DOI: 10.2169/internalmedicine.51.7218. View

20.

Ma L, Zhao S, Li Z . Effects of parathyroidectomy on bone metabolism in haemodialysis patients with secondary hyperparathyroidism. Scand J Clin Lab Invest. 2017; 77(7):527-534. DOI: 10.1080/00365513.2017.1354256. View