Abstract: PO0946
Successful Treatment of Systemic Calcinosis in a Teenager on Hemodialysis
Session Information
- Leveraging Technology and Innovation to Predict Events and Improve Dialysis Delivery
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Tufan pekkucuksen, Naile, University of Florida, Gainesville, Florida, United States
- Al-Humiari, Mohammed, University of Florida, Gainesville, Florida, United States
- Mannemuddhu, Sai Sudha, East Tennessee Children's Hospital, Knoxville, Tennessee, United States
- Shoemaker, Lawrence R., University of Florida, Gainesville, Florida, United States
Introduction
Systemic calcinosis is rare in pediatric ESKD patients compared to adults. The subcutaneous tissues are most frequently involved. We present teenager in whom calcinosis was detected incidentally on chest radiograph, and review its successful treatment.
Case Description
A 15 yo anuric female who had received hemodialysis(HD) for 18 months after renal transplant failure, was treated for progressive respiratory distress in the ICU. Significant history included osteoporosis, hypertensive cardiomyopathy, and renal failure since age 1. Chest-XR revealed bilateral pulmonary infiltrates and calcified lesions. Thoracic CT scan demonstrated calcified tracheal and bronchial cartilage rings.
Flexible bronchoscopy revealed diffuse white/gray nodules throughout the wall of tracheobronchial tree. All cultures were negative. When notified of the finding of calcifications on CT scan, patient’s mother also asked about the firm nodules in the space between patient’s fingers.
Dialytic phosphate (P) clearance, and non-calcium(Ca), non-aluminum(Al) based binder use were maximized, using sevelamer and lanthanum carbonate. Sodium thiosulfate and etalcalcetide were given iv post each dialysis. Dialysate Ca varied between 2.5-3 meq/L, to avoid hypocalcemic stimulation of PTH and high CaXP. Lanthanum was discontinued after 3 months, once P levels declined. Other therapies were continued for 10 months; with monthly dose adjustment. PTH level decreased and P levels normalized. Etelcalcitide was reduced to maintain normal Ca level. After 10 months, iv pamidronate was initiated to prevent further demineralization. This led to transient marked elevation in PTH. Combined therapies led to resolution of calcinosis. However, tracheobronchial calcifications have not been reassessed, since neither chest imaging nor bronchoscopy have been clinically indicated.
Discussion
Calcinosis is an uncommon, yet treatable condition in pediatric dialysis patients. Combined use of old and new therapies was successful. Adverse side effects of therapies affect dosing. Etelcalcitide often causes hypocalcemia. Thiosulfate use is associated with nausea. Lanthanum is an effective metal Ca binder, but prolonged use may lead to accumulation and systemic deposition. The emergence of new P binders: ferric citrate, sucroferric oxyhydroxide, and bixalomer will offer exciting new treatment options.