Serious cardiac and pulmonary calcification in a young peritoneal dialysis patient: potential role of continuous correction of acidosis.
We describe a 40-month-old male infant with renal failure, treated with peritoneal dialysis, who developed massive calcification of soft tissues including the heart and lungs with subsequent cardiopulmonary insufficiency. A diagnosis of Jeune syndrome was made. After starting peritoneal dialysis, the patient exhibited an intractable metabolic acidosis of unknown etiology necessitating treatment with intravenous or oral sodium bicarbonate. Myocardial calcification was first detected by 2-dimensional echocardiography performed 3 months after starting dialysis. The patient was not suitable for renal transplantation because of his cardiac dysfunction and died of cardiac and respiratory failure at the age of 6 years. Although the patient exhibited a variety of risk factors for ectopic calcification including hyperphosphatemia, hyperparathyroidism, high calcium-phosphate product and treatment with vitamin D, the early and massive soft tissue calcification may have been accelerated by correction of the metabolic acidosis. Therefore, the use of sodium bicarbonate may be involved in the etiology of the myocardial calcification.
Nakagawa
M
M
Department of Pediatrics, Shiga University of Medical Science, Seta, Otsu, Japan. masao@belle.shiga-med.ac.jp
Kise
K
K
Okamoto
N
N
Fujino
H
H
Iwai
M
M
Nomura
Y
Y
Sawa
H
H
D000138:Acidosis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D002114:Calcinosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D009202:Cardiomyopathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D004452:Echocardiography; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000628:therapy; D017693:Sodium Bicarbonate / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D017693:Sodium Bicarbonate