Pregnancy outcomes in patients on chronic dialysis have improved as a result of the intensification of dialysis and improved perinatal care. We report the successful outcome of a pregnancy in a patient on chronic haemodialysis in Cape Town, South Africa. With intensification of her therapy using thrice-weekly, nocturnal haemodialysis the pregnancy was maintained until 34 weeks at which time a 1.86 kg baby boy was delivered by elective caesarean section. One year later the patient was doing well on maintenance haemodialysis and the baby was achieving his developmental milestones. This report highlights our ability to employ a multi-disciplinary approach and prolonged, nocturnal haemodialysis to support pregnant dialysis patients in the South African setting and achieve good outcomes for both mother and baby.

Metastatic calcinosis cutis is an uncommon complication of end-stage kidney disease but has severe and disabling effects. Its development is attributed to disorders of calcium and phosphate metabolism associated with secondary hyperparathyroidism. The mainstay of treatment remains medical therapy; however, in refractory cases a parathyroidectomy is indicated. We describe the case of a 22-year-old female with refractory hyperparathyroidism treated with a subtotal parathyroidectomy resulting in complete resolution of metastatic calcinosis cutis of the hands. Clinicians should be aware that this complication can occur soon after the initiation of dialysis and that rapid complete resolution can be achieved with parathyroidectomy.

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