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Uremic tumoral calcinosis in a patient on hemodialysis.

A 45-year-old man with end-stage renal disease on hemodialysis for five years, presented with slowly progressive painful masses in bilateral shoulders, elbows and wrists. Laboratory investigation showed a normal serum calcium level, elevated serum phosphate level, and Ca×P product (5.4 mmol/L). X-ray demonstrated giant calcified masses in bilateral shoulders (Picture 1), elbows and wrists. Biopsy of the lesion showed multifocal deposition of calcium salt and formation of foreign body granuloma in the soft tissue (Picture 2). Then the calcium supplement therapy was discontinued, and the patient was treated with a low calcium dialysate. Both the patient’s pain and the lesion improved after 6 months (Picture 3). Tissue calcification is a common complication in patients on continuous hemodialysis for chronic renal failure (1), however severe calcification is unusual. The present case is a reminder to consider the importance of monitoring calcium and phosphate levels, and to focus on the overuse of calcium therapy.