ESPN 50th Annual Meeting

ESPN 2017


 
Metastatic Pulmonary Calcification (MPC) in a child with Chronic Kidney Disease (CKD) in Renal Replacement Therapy
LAURA CESCA 1 MATTIA PAROLIN 1 DAVIDE MENEGHESSO 1 ENRICO VIDAL 1 ELISA BENETTI 1 GERMANA LONGO 1 ANNACHIARA CAVALIERE 2 MICHELE BATTISTEL 2 FIORELLA CALABRESE 3 LUISA MURER 1

1- PEDIATRIC NEPHROLOGY DIALYSIS AND TRANSPLANTATION UNIT, DEPARTMENT FOR WOMAN AND CHILD HEALTH, UNIVERSITY OF PADUA
2- DEPARTMENT FOR IMAGING AND INTERVENTIONAL RADIOLOGY, UNIVERSITY OF PADUA
3- PATHOLOGY DEPARTMENT, UNIVERSITY OF PADUA
 
Introduction:

 

Different pulmonary or systemic conditions are associated with pulmonary calcifications, also described as calcium salt storages in lungs. A well accepted classification distinguishes metastatic calcifications where calcium storage occurs in a previously normal lung, from dystrophic calcifications, in which calcium is accumulated in a damaged lung. Though MPC is a quite rare condition, adult patients with CKD in hemodialysis (HD) often show this pulmonary pattern due to chronic calcium-phosphate imbalance.

Material and methods:

 

We report a case of a 12-year-old female with previous history of CKD in chronic PD treatment for 7 years and then in chronic HD due to peritoneal membrane failure. She was admitted to our Pediatric Nephrology Unit for urgent kidney transplantation without any symptoms. Routine preliminary investigations revealed a remarkable calcium-phosphate imbalance with a high level of intact parathyroid hormone (1326ng/L) and high levels of calcium and phosphate as seen in secondary hyperparathyroidsm. The inflammatory markers were not meaningful.

Results:

 

The chest X-ray showed an unexpected right upper lobe opacity. Previous Chest X-rays were negative. Because of the suspect of an infection, transplantation was not performed and investigations were started. Pulmonary infectious disease, arteriovenous malformations and granulomatous disorders were ruled out. To clarify the clinical picture a CT pulmonary angiogram was performed. During the precontrastography stage, an extensive calcification at the upper right lobe was revealed. The final diagnose was made after lung needle-biopsy, which demonstrated a limphomonocitary inflammation with diffuse alveolar calcium stones, referable to a pulmonary lithiasis.

Conclusions:

 

Although MPC is reported in pediatric patients with CKD, this is a rare complication, especially in the last years with the global improvement in CKD-MBD therapies. However, MCP must be considered in the differential diagnosis of unexplained lung opacities in children with CKD, mainly in the presence of secondary hyperparathyroidsm and strong clinical-radiological dissociation.