Extraosseous calcification in kidney disease

Abstract

A consequence of chronic and end-stage kidney disease is a higher risk of calcium deposition in sites other than the bones. The authors of this review outline current understanding of the pathogenesis, presentation, diagnosis, and treatment of this group of disorders. KEY POINTSExtraosseous calcifi cation is a broad term that encompasses vascular calcifi cation, soft tissue calcifi cation, and calciphylaxis, all of which are seen in patients with end-stage kidney disease.The pathogenesis of extraosseous calcifi cation is an active process involving a complex interplay of abnormal electrolyte levels, cell differentiation, and dysregulation of many biochemical pathways.Vascular calcifi cation is predominantly diagnosed incidentally, while soft tissue calcifi cation and calciphylaxis are diagnosed on the basis of radiographic and clinical presentation, sometimes requiring biopsy.Management is based on low-quality evidence and includes maintaining a neutral calcium balance, correcting hyperphosphatemia, and controlling comorbidities. Surgical and other nonmedical therapies may help somewhat in managing calciphylaxis and soft tissue manifestations.

Multiple Painless Masses in a Peritoneal Dialysis Patient

“…Tumoral calcinosis is a rare form of the extraosseous calcification in patients with advanced CKD, characterized by massive deposition of calcium-phosphorus crystals in periarticular areas. 1 Several CKD-MBD–related risk factors as demonstrated in this patient, including hypercalcemia, hyperphosphatemia, and an elevated calcium × phosphate product with coexistent severe hyperparathyroidism, have been implicated in the pathogenesis of this condition. 2 Medical history together with radiological evaluation plays a key role in the diagnosis of tumoral calcinosis.…”

Compressive myelopathy from diffuse spinal dural calcifications in a patient with end-stage renal disease: illustrative case

“…Paradoxical deposition of calcium phosphate nanocrystals leads to vascular and soft tissue calcifications, including, rarely, dural calcifications. [2][3][4][5] Intracranial dural calcifications in the setting of renal failure are a known complication, with some studies reporting an incidence of intracranial dural calcification up to 9.6% in dialysis patients. 6 Diffuse spinal dural calcification is much less frequently reported, and, to our knowledge, this case represents the first report of surgical decompression with duraplasty for the treatment of symptomatic spinal cord compression in the setting of diffuse dural calcification.…”

“…In the spine, these metabolic derangements can result in paradoxical responses, including weakened bones, aberrant calcium deposition, and other hallmarks of renal osteodystrophy. [1][2][3][4][5] This case report endeavors to contribute to the literature by exploring the complex interplay among ESRD, renal spinal osteodystrophy, secondary hyperparathyroidism, and diffuse dural calcifications culminating in symptomatic spinal cord compression. We intend to spotlight this unique mechanism of injury to the spinal cord, discuss surgical management options, and advocate for heightened clinical suspicion and accelerated diagnostic evaluation for this rare cause of compressive myelopathy.…”

Fetuin-a-based theranostics in ectopic calcification

“…This approach largely relies on maintaining hypocalcemia upon reduced bone degradation. However, the insufficient safety profile and severe side effects such as osteomalacia often lead to discontinuation of bisphosphonates [103]. Overall, bisphosphonates can be considered a more aggressive intervention aimed at alleviating vascular calcium burden in dialysis patients.…”