Peritoneal Dialysis and Uremic Tumoral Calcinosis: A Case Report of an Atypical Presentation and Review of the Literature

Аннотация

Background: Uremic tumoral calcinosis (UTC) is a rare complication associated with chronic kidney disease (CKD) and is commonly observed in patients with end-stage renal disease (ESRD) on dialysis, particularly hemodialysis. UTC is characterized by the deposition of calcium phosphate in soft tissues, most notably around joints, and is typically seen in patients with hyperphosphatemia, hyperparathyroidism, and elevated calcium- phosphate product. However, atypical manifestations of UTC, particularly in patients on peritoneal dialysis (PD), are seldom reported. Case Presentation: We report the case of a 62-year-old male with a history of ESRD on peritoneal dialysis who developed an unusual presentation of uremic tumoral calcinosis. The patient presented with an enlarging mass in the left shoulder, which was initially misdiagnosed as a soft tissue infection. Radiological and histopathological examination confirmed the diagnosis of UTC. The patient was managed with phosphate binders, adjustments to his dialysis regimen, and surgical debridement. Conclusion: This case highlights the importance of considering uremic tumoral calcinosis in the differential diagnosis of soft tissue masses in ESRD patients, even those on peritoneal dialysis. Early diagnosis and management are essential in preventing severe complications. We review the current literature on UTC in dialysis patients, emphasizing the need for vigilant monitoring and individualized treatment plans. Keywords: Uremic tumoral calcinosis, Peritoneal dialysis, Chronic kidney disease, Hyperphosphatemia, Tumoral calcinosis, End-stage renal disease, Soft tissue calcifications, Dialysis complications. The exact pathogenesis of UTC remains poorly Introduction: Uremic tumoral calcinosis (UTC) is a rare understood, but it is believed to result from an but serious complication in patients with end-stage imbalance between phosphate and calcium levels, as renal disease (ESRD) and chronic kidney disease (CKD), well as dysregulation of phosphate metabolism. The particularly those undergoing dialysis. The disease is calcifications typically affect the periarticular soft characterized by ectopic calcification, where calcium tissues, leading to swelling, pain, and restricted phosphate deposits accumulate in soft tissues, usually mobility. However, the presentation can vary around joints, leading to the formation of large, painful significantly from patient to patient, and atypical cases masses. The condition is most often associated with like the one presented in this report challenge our hyperphosphatemia, hyperparathyroidism, and an understanding of UTC. elevated calcium-phosphate product, which results from impaired renal excretion of phosphate in ESRD This case report focuses on a 62-year-old male patient patients. with ESRD on peritoneal dialysis, who presented with an unusual manifestation of UTC, which was initially While UTC is a well-established complication in misdiagnosed as a soft tissue infection. The review of hemodialysis patients, its occurrence in patients on the literature further explores the diagnosis, peritoneal dialysis (PD) is less commonly documented. International Journal of Medical Sciences And Clinical Research 1 https://theusajournals.com/index.php/ijmscr International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265) management strategies, and complications associated renal function declines, phosphate retention occurs, with UTC in dialysis patients. often leading to hyperphosphatemia. When phosphate levels exceed the kidney's ability to excrete it, calcium- Uremic tumoral calcinosis (UTC) is a rare but significant phosphate crystals may form and deposit in soft complication seen in patients with chronic kidney tissues, leading to calcifications. In patients with ESRD, disease (CKD) and end-stage renal disease (ESRD), elevated parathyroid hormone (PTH) levels—due to particularly those undergoing dialysis. This condition is secondary hyperparathyroidism—further contribute to characterized by the deposition of calcium phosphate this imbalance, intensifying the deposition of these crystals in soft tissues, typically around joints, and can crystals in soft tissues. lead to painful, large masses. While more commonly observed in hemodialysis patients, there have been Typically, UTC manifests as large, palpable masses increasing reports of UTC occurring in individuals around joints, particularly the elbows, shoulders, and undergoing peritoneal dialysis (PD), albeit less hips. These calcified masses are often painful and can frequently. The pathology of UTC is believed to stem restrict joint mobility, leading to significant morbidity. from the imbalance in phosphate and calcium The condition is most commonly seen in patients metabolism in CKD patients, exacerbated by renal undergoing hemodialysis; however, peritoneal dialysis insufficiency. However, the exact mechanisms leading patients are not immune to this complication, though it to