Arthropathy and cutaneous calcinosis in hemodialysis oxalosis

Reginato, Antonio J.; Seoane, J L Ferreiro; Álvarez, Corrales; Piferrer, J Mitja; Meijon, L Vidal; Turon, R; Vásconez, Fábian; Rivera, E. R.; Clayburne, G.; Rothfuss, S

doi:10.1002/art.1780291112

Cited by 64 publications

(26 citation statements)

References 24 publications

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“…These diseases typically have soft tissue calcification [5,20,23] which distinguishes them from amyloid bone disease occurring in dialysis patients where soft tissue calcification is absent.…”

Section: Discussionmentioning

confidence: 98%

Growing bone cysts in long-term hemodialysis

et al. 1990

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All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven.

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Section: Discussionmentioning

confidence: 98%

Growing bone cysts in long-term hemodialysis

et al. 1990

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“…Acute first MTP arthritis, resembling gouty podagra, has been described in 3 other forms of crystal-induced arthritis (4,5,15,16). There are rare case reports of acute hydroxyapatite arthritis of the first MTP joint due to intraarticular deposition of hydroxyapatite crystals (5).…”

Section: Discussionmentioning

confidence: 99%

Hydroxyapatite pseudopodagra. A syndrome of young women

Fam

Rubenstein

1989

Arthritis & Rheumatism

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Six women with acute calcific periarthritis of the first metatarsophalangeal joint (hydroxyapatite pseudopodagra) are described, and 10 previously reported cases (8 female patients and 2 male patients) are reviewed. The onset was characterized by acute pain, swelling, erythema, tenderness, and limitation of movement of the first metatarsophalangeal joint, symptoms indistinguishable from those of gouty podagra, which is associated with transient amorphous calcific deposits in the vicinity of the joint. Based on these results it appears that hydroxyapatite pseudopodagra is a disorder that predominantly affects premenopausal women.Acute calcific periarthritis (ACP) is a disorder characterized by acute periarticular inflammation associated with juxtaarticular deposits of calcium hydroxyapatite (1-3). Both sexes are equally affected, most commonly between the ages of 40 and 60 years (1,3). The majority of cases are sporadic and idiopathic, although there are rare familial forms, and the syndrome has also been described in association with long-term hemodialysis for renal insufficiency (2,3). The calcific deposits are usually monarticular, although they can be polyarticular and recurrent (3). The shoulder is the most commonly affected site, followed by the hip, knee, elbow, wrist, and ankle joints. Involvement of the joints of the feet and toes is rare, accounting for <1% of all cases (1).During a 1-year period, we treated 3 young women with ACP of the first metatarsophalangeal (MTP) joint. This prompted us to restudy 3 patients previously seen at our institution, and to review the literature. Our results indicate that ACP of the first MTP joint is an uncommon cause of pseudopodagra ( 4 3 , and that the disorder predominantly affects premenopausal women. PATIENTS AND METHODSPatients. Three young women with ACP of the first MTP joint were seen within a I-year period by one of us (AGF), prompting this investigation. Subsequently, the records of 3 patients treated previously at Sunnybrook Medical Centre, including 2 previously reported cases (2), were reviewed, and a computer-assisted literature search was carried out. Criteria for entry into the study included the acute onset of localized pain, swelling, and tenderness at the base of the great toe, together with radiologic evidence of corresponding, amorphous calcification in the periarticular tissues of the first MTP joint. No patient had gout, pseudogout, or diseases associated with subcutaneous calcinosis, such as scleroderma.Clinical evaluation. A retrospective analysis was done of the following historical data: age, sex, mode of presentation, prior trauma to or overuse of the joint, description and duration of the acute attack, initial diagnosis, time required for proper diagnosis, associated medical illnesses, previous episodes, and familial occurrence.General physical and musculoskeletal examinations were performed. Patients were evaluated for any underlying

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“…Reversal o f cardiac dysfunc tion from oxalate deposits has been demonstrated in such patients [19]. In uremic patients without PH O , secondary oxalosis may occur, and end-organ damage has been re ported [20][21][22], Our patients had a rapid fall in urine and serum oxalate toward normal, though there was a tendency for the levels to remain slightly higher than in normal subjects. Due to the interindividual variability, the dif ference was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Effect of Renal Transplantation on Serum Oxalate and Urinary Oxalate Excretion

Worcester¹,

Fellner²,

Nakagawa³

et al. 1994

Nephron

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Serum levels of oxalate are elevated in uremic patients on dialysis. The effect of living related donor kidney transplants on serum and urine oxalate levels was studied in 8 patients. Serum and urine oxalate levels were measured prior to transplant, on the day of transplant and daily for 5 days postoperatively, and the results compared to those in 11 normal subjects. All transplanted kidneys functioned immediately. Serum oxalate fell from 55 ± 9 μmol/l (484 ± 79 μg/dl) before transplant to 21 ± 3 μmol/l (185 ± 26 μg/dl) the day after transplant, and to 9 ± 2 μmol/l (79 ± 18 μg/dl) 72 h after transplant. Serum oxalate in normal subjects was 9 ± 2 μmol/l (79 ± 18 μg/dl). During the initial 24 h after transplant urine oxalate averaged 1,244 ± 150 μmol/l (109.5 ± 13.2 mg), but fell to levels not statistically different from normal by 72 h after transplant. Rapid clearance of oxalate after transplant leads to transient hyperoxaluria until normal levels of serum oxalate are reached.

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Arthropathy and cutaneous calcinosis in hemodialysis oxalosis

Cited by 64 publications

References 24 publications

Growing bone cysts in long-term hemodialysis

Growing bone cysts in long-term hemodialysis

Hydroxyapatite pseudopodagra. A syndrome of young women

Effect of Renal Transplantation on Serum Oxalate and Urinary Oxalate Excretion

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