Sudden fatal pulmonary calcification following renal transplantation.
A 42-year-old male was hemodialyzed for 2 years with excellent control of calcium-phosphate metabolism. He received a cadaveric renal transplant but experienced a prolonged episode of acute tubular necrosis during which he could not tolerate phosphate-binding antacids. His calcium X phosphate product became markedly elevated for 20 days. Following a brief period of function, the homograft was removed on the 45th post-transplant day after severe rejection and subsequent infection. Chest X-ray was normal. Six days after graft nephrectomy, he became acutely dyspneic and markedly hypoxemic. Diffuse, flocculent pulmonary infiltrates appeared on the chest film. The patient expired 1 day later. At postmortem examination, there was severe, diffuse pulmonary alveolar calcification demonstrated by chemical and histologic examination. Although unlikely, the prolonged post-transplant period characterized by elevated calcium X phosphate product may have played a pathogenetic role. Calciphylaxis may have occurred, with hyperparathyroidism as the sensitizing agent and any of several drugs acting as challenger.
D000328:Adult; D002114:Calcinosis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D002130:Calcium Phosphates / Q000097:blood; D006801:Humans; D016030:Kidney Transplantation; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008297:Male; D010758:Phosphorus / Q000097:blood; D011183:Postoperative Complications; D014184:Transplantation, Homologous
D002130:Calcium Phosphates; D010758:Phosphorus