Rapid onset metastatic pulmonary calcifications in end‐stage renal disease

Abstract

Metastatic calcification occurs in patients on long‐term dialysis. Electrolyte imbalances in these individuals can result in calcium deposition into otherwise normal tissues. In this article, we present the unusual case of a patient who progressed to end‐stage renal disease soon after a liver transplant and developed extensive pulmonary metastatic calcifications within a few months of starting dialysis. A 56‐year‐old female underwent an orthotopic liver transplant for end‐stage liver disease secondary to hepatitis C; her immunosuppression included tacrolimus and prednisone. She developed acute kidney injury in the immediate post‐operative period, which progressed to end‐stage renal disease. Her serum calcium and phosphorus levels were within normal limits. Within a few months, a CT scan of her chest showed progressive development of metastatic pulmonary calcification. A CT‐guided right lung biopsy showed extensive calcification in the alveolar and blood vessel walls with fibroblastic plugs in the alveolar spaces. To our knowledge, this is the first report of metastatic pulmonary calcification developing rapidly after initiation of hemodialysis. Immunosuppressive therapy may have played a role in the development of metastatic calcification.

Metastatic pulmonary calcification – a and review of the literature

“…Metastatic pulmonary calcification (MPC) is calcium deposition in previously healthy pulmonary tissue due to TORAKOCHIRURGIA metabolic and electrolytic disorder in the course of chronic renal insufficiency treated by long-lasting dialysis [2][3][4]6]. The deposition foci in the form of tumors of size 2-12 mm can be localized or bilaterally disseminated, accompanied by infiltration areas, mimicking pneumonitis with fibroproliferation and lymphadenopathy.…”

“…Lastly, tissue alkalosis enables development of MPC, and that is why the upper parts of the lungs are involved. Metastatic pulmonary calcification may also be triggered by vitamin D hypervitaminosis, orthotopic liver transplantation, immunosuppression, milk alkali syndrome, some neoplastic syndromes and ARDS (adult respiratory distress syndrome) [2,4,6,14,15]. Metastatic pulmonary calcification is often undiagnosed due to low sensitivity of classic radiography and benign, symptomless course at the beginning, though it is present in 60-70% of autopsies of dialysis-dependent patients.…”

“…Metastatic pulmonary calcification is often undiagnosed due to low sensitivity of classic radiography and benign, symptomless course at the beginning, though it is present in 60-70% of autopsies of dialysis-dependent patients. Metastatic pulmonary calcification usually occurs after several years of dialysis, though sometimes it occurs after just a few months of this therapy [2,6,12,16]. The clinical progress of the disease is unpredictable.…”

“…osteo-and chondrosarcoma, adenocarcinoma and benign neoplasm, i.e. hamartoma [1][2][3][4]. Metastatic etiology of calcification foci in the lung tissue is a rarity in thoracic surgery.…”

“…Metastatic etiology of calcification foci in the lung tissue is a rarity in thoracic surgery. The available medical literature describes casuistic cases or short series only [1][2][3][4].…”