A 45-year-old man with chronic kidney graft failure was admitted to our hospital for dialysis. He had undergone kidney transplantation at 15 years of age because of unspecified glomerulonephritis. After the transplantation, immunosuppressive therapy was administered and the transplanted kidney function was maintained in a good condition. However, the transplanted kidney failure developed gradually, probably because of chronic rejection. The patient showed general fatigue, poor appetite and marked leg edema.

He underwent hemodialysis on admission to our hospita. His condition improved gradually. However, he had lumbago and had stiffness of the hip. His abdominal computed tomography (CT) scan is shown in Figure 1. Remarkable metastatic calcification was noted around his hips. His laboratory results were as follow: Hb - 7.1 g/dL, serum total protein - 5.2 g/dL, serum albumin - 2.0 g/dL, BUN - 49 mg/dL, Cr - 6.3 mg/dL, Na - 134 mEq/L, K - 4.3 mEq/L, Cl - 103 mEq/L, Ca - 10.2 mg/dL, P - 6.2 mg/dL, ALP - 488 U/L, serum ß2-microgloburin - 35.9 µg/mL, CRP - 3.8 mg/dL, intact-PTH - 6 pg/mL. Because serum calcium levels were very elevated, the administration of vitamin D3 [1a, 3a-(5Z, 7E)-isomer 1-hydroxycholecalciferol] was discontinued

Metastatic calcification is usually observed in patients with end-stage renal disease. [1] Generally, they are observed around a joint, soft tissue, vascular wall, lung, and heart, and they often induce acute arthritis, hypertension, hypoxemia and heart failure. [1] Metastatic calcification is associated with the metabolism of phosphate, calcium and parathyroid hormone. Consequently, for successful treatment, controlling the serum levels of phosphate, calcium and parathyroid hormone is very important. [2] The agents we can use as a drug for metastatic calcification are calcium carbonate, sevelamer and etidronate (bisphosphonate). [3]

Severe metastatic calcification such as that observed in the present case is very rare, however, we should pay attention to serum level of calcium in patients with end-stage renal disease.

1. Goodman WG. Medical management of secondary hyperparathyroidism in chronic renal failure. Nephrol Dial Transplamt 2003;(Suppl 3):iii2–8.   [CrossRef]   [Pubmed]    
2. Goel SK, Bellovich K, McCullough PA. Treatment of severe metastatic calcification and calciphylaxis in dialysis patients. Int J Nephrol 2011 Feb;24:701603.   [CrossRef]   [Pubmed]    
3. Shiraishi N, Kitamura K, Miyoshi T, et al. Successful treatment of a patient with severe calcific uremic arteriolopathy (calciphylaxis) by etidronate disodium. Am J Kidney Dis 2006 Jul;48:151–4.   [CrossRef]   [Pubmed]