RESUMEN
Successful kidney transplant corrects mineral and bone disorderto a large extent; however, disorders can persistin up to 80% ofrecipients.We describe a case of persistent hyperparathyroidism with graft dysfunction and metastatic calcification in graft biopsy. A 48-yearold renal transplant recipient developed graft dysfunction 3 weeks after kidney transplant. During pretransplant workup, the recipient was found to have severe secondary hyperparathyroidism (intact parathyroid hormone level of 2000 pg/mL), which was managed and well controlled before transplant. Graft dysfunction was evaluated using algorithmic approach. Prerenal causes, tacrolimus toxicity, and infections were ruled out. Graft biopsy revealed several foci of tubular and parenchyma calcific deposits (microcalcinosis) with tubular injury. The patient was restarted on medical management of hyperparathyroidism, and he showed improvement over 6 weeks, along with creatinine level returning to nadir value. Vascular and graft calcification is an independent predictor of long-term graftfunction and overall mortality. This report describes the challenges that we faced in diagnosis and management of persistent hyperparathyroidism, as no randomized controlled trials and guidelines are available.
Asunto(s)
Calcinosis , Hiperparatiroidismo Secundario , Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Hiperparatiroidismo Secundario/etiología , Hiperparatiroidismo Secundario/diagnóstico , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Biopsia , Calcinosis/etiología , Calcinosis/cirugía , Calcinosis/diagnóstico , Aloinjertos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Biomarcadores/sangre , Factores de Tiempo , Enfermedades Renales/etiología , Enfermedades Renales/diagnóstico , Hormona ParatiroideaRESUMEN
BACKGROUND: We report a rare case of posterior cruciate ligament (PCL) calcification, which has only been reported in two case studies on PubMed. CASE PRESENTATION: A 71-year-old man developed left popliteal pain in the morning without any history of trauma and the pain became severe that night. On the following day, he presented to our department. The patient could not flex his left knee at all due to pain and swelling. CT and MRI scans showed calcification behind the PCL with mild osteoarthritic changes and accumulation of synovial fluid in the joint. Synovial fluid analysis did not reveal any crystals. Blood tests at first admission showed inflammation, hyperglycemia, and low blood uric acid levels. Although the patient's knee joint was injected with steroids, his symptoms did not improve. Thus, we performed arthroscopic surgery two days after symptoms had appeared. Intraoperatively, we observed a white, soft tissue in the synovial membrane behind the PCL. Part of this tissue was collected for histological analysis, which revealed sparse fibers with calcium deposits. Immediately after surgery, the patient's symptoms were completely gone. Afterward, the patient remained asymptomatic one month after surgery. CONCLUSION: This is the first reported case of debridement of PCL calcification and ossification that was performed soon after symptoms appeared. In addition, we demonstrated that early debridement led to complete recovery.
Asunto(s)
Artroscopía , Calcinosis , Desbridamiento , Ligamento Cruzado Posterior , Humanos , Masculino , Anciano , Calcinosis/cirugía , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Ligamento Cruzado Posterior/cirugía , Ligamento Cruzado Posterior/lesiones , Resultado del Tratamiento , Recuperación de la Función , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Imagen por Resonancia MagnéticaRESUMEN
Fibrocalculous pancreatic diabetes (FCPD) mellitus is a distinct type of diabetes that arises from chronic calcification of the pancreas in young, nonalcoholic individuals, predominantly in tropical regions. The characteristic triad of FCPD includes diabetes, abdominal pain, and steatorrhea. Additional notable features of the disease are its early age of onset, the presence of large intraductal stones, rapid disease progression, and a heightened risk of developing pancreatic cancer. Tuberculosis (TB) is a health concern worldwide and is responsible for a major health burden in developing countries like India. TB involving any organ other than the lungs is diagnosed as extrapulmonary tuberculosis (EPTB). EPTB with musculoskeletal involvement is often a difficult and delayed diagnosis because of unusual clinical presentations.
Asunto(s)
Calcinosis , Tuberculosis Extrapulmonar , Humanos , Calcinosis/etiología , Enfermedades Pancreáticas/complicaciones , Enfermedades Pancreáticas/diagnóstico , Tuberculosis Extrapulmonar/complicaciones , Tuberculosis Extrapulmonar/diagnósticoRESUMEN
OBJECTIVE: This study was to investigate the role of serum Klotho, fetuin-A, and Matrix Gla Protein (MGP) in Coronary Artery Calcification (CAC) in patients with Maintenance Hemodialysis (MHD) and their predictive value for CAC. METHODS: 100 patients receiving MHD were selected. Serum Klotho, fetuin-A, and MGP levels were detected by ELISA. CAC scores were assessed by coronary CT scan. Multifactor analysis was used to evaluate the risk factors affecting CAC. The ability of serum Klotho, fetuin-A, and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves. RESULTS: Serum Klotho, fetuin-A, and MGP were independent risk factors for CAC. Serum Klotho, fetuin-A, and MGP were valuable in the diagnosis of CAC in MHD patients. CONCLUSION: There is a close relationship between Klotho, fetuin-A, and MGP levels in MHD patients and CAC.
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Biomarcadores , Proteínas de Unión al Calcio , Enfermedad de la Arteria Coronaria , Proteínas de la Matriz Extracelular , Glucuronidasa , Proteínas Klotho , Proteína Gla de la Matriz , Diálisis Renal , Calcificación Vascular , alfa-2-Glicoproteína-HS , Humanos , Diálisis Renal/efectos adversos , Masculino , Femenino , Proteínas de Unión al Calcio/sangre , Persona de Mediana Edad , alfa-2-Glicoproteína-HS/análisis , alfa-2-Glicoproteína-HS/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Glucuronidasa/sangre , Proteínas de la Matriz Extracelular/sangre , Biomarcadores/sangre , Calcificación Vascular/sangre , Calcificación Vascular/diagnóstico por imagen , Anciano , Factores de Riesgo , Ensayo de Inmunoadsorción Enzimática , Adulto , Curva ROC , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Valor Predictivo de las PruebasAsunto(s)
Válvula Aórtica , Calcinosis , Transducción de Señal , Quinasas Asociadas a rho , Humanos , Quinasas Asociadas a rho/metabolismo , Calcinosis/etiología , Calcinosis/metabolismo , Válvula Aórtica/patología , Válvula Aórtica/metabolismo , Enfermedad de la Válvula Aórtica/metabolismo , Proteína de Unión al GTP rhoA/metabolismo , Estenosis de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/metabolismoRESUMEN
Tendon calcification is a common clinical condition that frequently occurs as a complication after tendon injury and surgery, or as an expression of fibrodysplasia ossificans progressiva. This condition can be referred to by various names in clinical practice and literature, including tendon ossification, tendon mineralization, heterotopic ossification, and calcific tendonitis. The exact pathogenesis of tendon calcification remains uncertain, but current mainstream research suggests that calcification is mostly cell mediated. To further elucidate the pathogenesis of tendon calcification and to better simulate the overall process, selecting appropriate experimental animal models is important. Numerous animal models have been utilized in various clinical studies, each with its own set of advantages and limitations. In this review, we have discussed the advancements made in research on animal models of tendon calcification, with a focus on the selection of experimental animals, the sites of injury in these models, and the methods employed for modeling.
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Calcinosis , Modelos Animales de Enfermedad , Tendones , Animales , Calcinosis/patología , Calcinosis/etiología , Tendones/patología , Tendinopatía/patología , Tendinopatía/etiología , Traumatismos de los Tendones/patología , HumanosRESUMEN
Calcinosis cutis is a condition that is commonly associated with autoimmune connective tissue diseases. It is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue, which can cause pain, impair function, and have significant impacts on quality of life. Calcinosis cutis is difficult to manage because there is no generally accepted treatment: evidence supporting treatments is mostly comprised of case reports and case series, sometimes yielding mixed findings. Both pharmacologic and procedural interventions have been proposed to improve calcinosis cutis, and each may be suited to different clinical scenarios. This review summarizes current treatment options for calcinosis cutis, with discussion of recommendations based on patient-specific factors and disease severity.
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Enfermedades Autoinmunes , Calcinosis , Enfermedades del Tejido Conjuntivo , Enfermedades de la Piel , Humanos , Calcinosis/diagnóstico , Calcinosis/terapia , Calcinosis/etiología , Calcinosis/patología , Calcinosis/inmunología , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/diagnóstico , Enfermedades de la Piel/etiología , Enfermedades de la Piel/terapia , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/inmunología , Enfermedades Autoinmunes/terapia , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Calidad de Vida , Piel/patología , Piel/inmunología , Calcinosis CutisRESUMEN
A Japanese woman in her 70s was referred to our hospital for the evaluation and treatment of high intraocular pressure (IOP) in her right eye. She had undergone bilateral cataract surgeries and the insertion of hydrophilic acrylic intraocular lenses (IOLs). We performed trabeculotomy and trabeculectomy to lower her right IOP; thereafter, a circular opacity was observed on the right eye's IOL surface. We removed the right IOL because that eye's vision had decreased due to IOL opacification. The analysis of the removed IOL revealed that the main opacity component was calcium phosphate. This is the first post-glaucoma-surgery IOL calcification case report.
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Calcinosis , Glaucoma , Lentes Intraoculares , Humanos , Femenino , Lentes Intraoculares/efectos adversos , Calcinosis/etiología , Anciano , Glaucoma/cirugía , Glaucoma/etiología , Implantación de Lentes Intraoculares/efectos adversos , Complicaciones Posoperatorias/etiologíaRESUMEN
This article discusses a rare clinical case of differential diagnosis between salivary stone disease and calcinosis, which developed against the background of autoimmune pathology. Diagnosis of these pathologies causes difficulties for practitioners, and treatment methods have fundamental differences. In this regard, the description of this case is relevant and significant. The algorithm of the main and additional research methods to confirm the diagnosis is described.
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Calcinosis , Glándula Parótida , Síndrome de Sjögren , Humanos , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/diagnóstico , Calcinosis/patología , Calcinosis/diagnóstico , Calcinosis/etiología , Femenino , Diagnóstico Diferencial , Glándula Parótida/patología , Persona de Mediana EdadAsunto(s)
Calcinosis , Dermatomiositis , Humanos , Dermatomiositis/inmunología , Dermatomiositis/tratamiento farmacológico , Dermatomiositis/complicaciones , Dermatomiositis/diagnóstico , Calcinosis/tratamiento farmacológico , Calcinosis/inmunología , Calcinosis/etiología , Calcinosis/diagnóstico por imagen , Calcinosis/diagnóstico , Resultado del Tratamiento , Femenino , Niño , Masculino , Inmunoglobulinas/administración & dosificación , Inyecciones SubcutáneasAsunto(s)
Calcinosis , Carcinoma de Células Renales , Neoplasias Renales , Nefrectomía , Humanos , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/patología , Nefrectomía/efectos adversos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Calcinosis/etiología , Calcinosis/patología , Calcinosis/cirugía , Masculino , Tomografía Computarizada por Rayos X , Persona de Mediana EdadRESUMEN
BACKGROUND: Recent studies highlighted the presence of anti-α-Gal antibodies in patients implanted with commercial bioprosthetic heart valves (BHVs). BHVs expose residual α-Gal xenoantigen and their recognition by the circulating anti-Gal antibodies leads to opsonization of the device's tissue component with the consequent triggering of a deterioration pathway that culminates with calcification. Small animal models such as mice and rats have been broadly involved in the in vivo testing of biomaterials by subcutaneous implantation, especially for the effectiveness of BHVs anti-calcific treatments. However, since models employed for this purpose express α-Gal antigen, the implantation of BHVs' leaflets does not elicit a proper immunological response, so the calcification propensity may be dramatically underestimated. METHODS: An α-Gal knockout (KO) mouse model has been created, using the CRISP/Cas9 approach, and adopted to assess the calcification potential of commercial BHVs leaflets through the surgical implantation in the back subcutis area. Calcium quantification was performed by inductively coupled plasma analysis; immune response against the BHVs leaflets and α-Gal silencing was evaluated through immunological assays. RESULTS: Two months after the implantation of commercial BHV leaflets, the anti-Gal antibody titers in KO mice doubled when compared with those found in wild-type (WT) ones. Leaflets explanted from KO mice, after one month, showed a four-time increased calcium deposition concerning the ones explanted from WT. The degree of silencing of α-Gal varied, depending on the specific organ that was assessed. In any case, the animal model was suitable for evaluating implanted tissue responses. CONCLUSIONS: Such mouse model proved to be an accurate tool for the study of the calcific propensity of commercial BHVs leaflets than those hitherto used. Given its reliability, it could also be successfully used to study even other diseases in which the possible involvement of α-Gal has been observed.
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Bioprótesis , Calcinosis , Modelos Animales de Enfermedad , Prótesis Valvulares Cardíacas , Ratones Noqueados , Animales , Calcinosis/inmunología , Calcinosis/etiología , Ratones , Ratones Endogámicos C57BL , MasculinoRESUMEN
Diabetes mellitus type 3 refers to diabetes secondary to an existing disease or condition of the exocrine pancreas and is an uncommon cause of diabetes occurring due to pancreatogenic pathology. It accounts for 15-20% of diabetic patients in Indian and Southeast Asian continents. This is case report of a rare case of type 3 diabetes mellitus (T3DM) presenting with diabetic ketoacidosis (DKA). The patient was admitted for DKA along with complaint of hyperglycemia, blood glucose of 405 mg/dl with HbA1c level of 13.7%. Computed tomography evidence revealed chronic calcific pancreatitis with intraductal calculi and dilated pancreatic duct.
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Calcinosis , Cálculos , Cetoacidosis Diabética , Conductos Pancreáticos , Pancreatitis Crónica , Humanos , Cetoacidosis Diabética/complicaciones , Cetoacidosis Diabética/diagnóstico , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/diagnóstico , Pancreatitis Crónica/diagnóstico por imagen , Cálculos/complicaciones , Cálculos/diagnóstico por imagen , Cálculos/diagnóstico , Conductos Pancreáticos/patología , Conductos Pancreáticos/diagnóstico por imagen , Calcinosis/etiología , Calcinosis/diagnóstico , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Masculino , Adulto , Tomografía Computarizada por Rayos XRESUMEN
Acute calcific periarthritis (ACP) in the interphalangeal joints of the hand is rare, with less than 100 cases reported. A rare case of ACP in a proximal interphalangeal (PIP) joint of the hand, in a young black woman, after acute trauma, is presented. She experienced severe pain and limited range of motion, and was medicated with an oral corticoid, which was followed by a rapid resolution of the symptoms. At six months, there were no signs of clinical or radiographic recurrence. Recognition of ACP allows for avoiding unnecessary treatments. In this case, treatment with corticoids might have played a role in a faster recovery.
La periartritis calcificada aguda (PCA) en las articulaciones interfalángicas de la mano es rara, con menos de 100 casos reportados. Se presenta un caso raro de PCA en una articulación interfalángica proximal (IFP) de la mano, en una mujer joven de raza negra, después de un traumatismo agudo. Experimentó dolor intenso y rango de movimiento limitado, y fue medicada con un corticoide oral, lo que fue seguido por una rápida resolución de los síntomas. A los seis meses no hubo signos de recurrencia clínica ni radiológica. El reconocimiento de PCA permite evitar tratamientos innecesarios. En este caso, el tratamiento con corticoides podría haber contribuido a una recuperación más rápida.
Asunto(s)
Calcinosis , Articulaciones de los Dedos , Periartritis , Humanos , Femenino , Calcinosis/etiología , Enfermedad Aguda , Traumatismos de los Dedos , AdultoRESUMEN
Background: Encapsulating peritoneal sclerosis (EPS) is a rare complication of prolonged peritoneal dialysis (PD) exposure, characterised by peritoneal thickening, calcification, and fibrosis ultimately presenting with life-threatening bowel obstruction. The presence or role of peritoneal calcification in the pathogenesis of EPS is poorly characterised. We hypothesise that significantly aberrant bone mineral metabolism in patients on PD can cause peritoneal calcification which may trigger the development of EPS. We compared the temporal evolution of bone mineral markers during PD in EPS patients with non-EPS long-term PD controls. Methods: Linear mixed model and logistic regression analysis were used to compare four-monthly serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase (ALP) over the duration of PD exposure in 46 EPS and 46 controls (PD, non-EPS) patients. Results: EPS patients had higher mean calcium (2.51 vs. 2.41 mmol/L) and ALP (248.00 vs. 111.13 IU/L) levels compared with controls (p=0.01 and p<0.001 respectively, maximum likelihood estimation). Logistic regression analysis demonstrated that high serum calcium and phosphate levels during PD were associated with a 4.5 and 2.9 fold increase in the risk of developing EPS respectively. Conclusion: High levels of calcium and phosphate in patients on PD were identified to be risk factors for EPS development. Possible reasons for this may be an imbalance of pro-calcifying factors and calcification inhibitors promoting peritoneal calcification which increases peritoneal stiffness. Mechanical alterations may trigger, unregulated fibrosis and subsequent development of EPS. Improved management of secondary hyperparathyroidism during PD may ultimately diminish the EPS risk.