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      Treatment of Uremic Tumoral Calcinosis in Maintenance Hemodialysis Patients

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          Abstract

          Background/Aims: Uremic tumoral calcinosis (UTC) is a rare disease with metastatic tissue calcification in maintenance hemodialysis (HD) patients. However, limited data are available on the treatment of UTC in HD patients. This article mainly discusses the diagnostic findings and efficacy of treatment on HD patients with UTC. Methods: A retrospective analysis was conducted based on the data of 13 cases of UTC, including their clinical features, biochemical indicators, imaging findings, diagnosis, therapeutic methods, and follow-up results. Parathyroidectomy (PTX) or drug treatment was determined based on intact parathyroid hormone (iPTH) levels and clinical symptoms. Results: All 13 patients were diagnosed as UTC definitely by imaging examination. The predominant areas involved were the buttocks (4 cases, 30.77%), shoulders (4 cases, 30.77%), and elbows (3 cases, 23.08%). Based on the levels of iPTH, cases were categorized into 2 different groups: PTX treatment group was associated with high levels of iPTH, while drug treatment group (lanthanum carbonate or sevelamer with sodium thiosulfate) was associated with lower iPTH levels. After PTX treatment, there was a significant decrease in serum iPTH, calcium (Ca), phosphate (P), and alkaline phosphatase levels ( p < 0.05). In drug treatment group, the serum p levels were decreased significantly, along with a finding that hemoglobin levels were increased ( p < 0.05). All the UTC had lessened or even disappeared after 4–6 months treatment. Conclusions: Although most UTC patients have an increased iPTH, a small number had lower iPTH levels. Based on iPTH levels and clinical symptoms, the patients were treated with PTX or drug therapy. With proper treatment, UTC disappeared without the need for surgery to remove calcinosis tissue.

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          Author and article information

          Journal
          BPU
          Blood Purif
          10.1159/issn.0253-5068
          Blood Purification
          S. Karger AG
          0253-5068
          1421-9735
          2020
          November 2020
          14 April 2020
          : 49
          : 6
          : 658-664
          Affiliations
          aThe Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
          bDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
          cDepartment of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
          dSchool of Medicine, South China University of Technology, Guangzhou Higher Education Mega Centre, Guangzhou, China
          eDepartment of Nephrology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China
          fDepartment of Thoracic Surgery, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China
          gDepartment of Nephrology, Huidong People’s Hospital, Huidong, China
          hDepartment of Nephrology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
          iDepartment of Nephrology, Zhuhai People’s Hospital, Zhuhai, China
          jDepartment of Otolaryngology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
          Author notes
          *Dr. Pingjian Ge, Department of Otolaryngology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080 (PR China), E-Mail gepingjiang@aliyun.com, , Dr. Shuangxin Liu, Department of Nephrology, Guangdong Provincial People’s Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515 (China), E-Mail 13543456446@163.com
          Article
          506115 Blood Purif 2020;49:658–664
          10.1159/000506115
          32289781
          © 2020 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Figures: 2, Tables: 4, Pages: 7
          Categories
          Research Article

          Cardiovascular Medicine, Nephrology

          Uremic tumoral calcinosis, Hemodialysis, Treatment

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