title: Severe asymptomatic coronary obstruction in chronic hemodialysed patient - a case report.
abstract: Introduction.Arterial stiffness and vascular calcifications are independent predictors of cardiovascular morbidity and mortality in the chronic kidney disease (CKD) stage 5D population. According to the guidelines, patients on renal replacement therapy represent a very high cardiovascular risk class.Case report.We report the case of a 67-year-old hypertensive male patient, known with CKD stage 5D on hemodialysis (three times per week), secondary bone mineral disease, admitted for progressive right leg pain. The physical examination detected right dorsalis pedis artery pulse absence. Blood biochemistry emphasized hypercalcemia, hyperphosphatemia, increased alkaline phosphatase, metabolic acidosis, hypoalbuminemia, iPTH values above upper limits. The X-ray of right shin highlighted a vascular calcification with a "train track" aspect on the tibial-peroneal artery trunk and the thoracic X-ray (performed with low ray regime) showed calcium deposits in coronary arteries walls. Legs arteriography and coronary angiography were performed revealing multiple lesions on investigated vessels with an 80% narrowing of right coronary artery. The particularity of the case lies in the absence of angina in a chronic hemodialysis patient in whom multiple significant angiographically stenosis of the coronary arteries were found and successful endovascular therapy was performed.Conclusion.The broadening of the indication for coronary angiography should be considered in certain asymptomatic CKD stage 5D patients based on a risk score involving calcium, phosphate, PTH and acid-base imbalances, while considering their major influence on the structure and tone of vascular walls thus on cardiovascular morbidity and mortality rates.Abbreviations.ABI = ankle-brachial index,CAD = coronary artery disease,CKD = chronic kidney disease,CT = computed tomography, EBCT = electron-beam computed tomography,ESRD = end-stage renal disease,GFR = glomerular filtration rate,iPTH = intact parathormon,PCI = percutaneous coronary intervention.
authors.affiliation: Department of Internal Medicine, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania ; 1st Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Voiculeț
authors.affiliation: Department of Angiography, Catheterization and Electrophysiology, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania.
authors.forename: O
authors.initials: O
authors.lastname: Zara
authors.affiliation: Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania ; 3rd Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Văcăroiu
authors.affiliation: Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania ; 3rd Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Bogeanu
authors.affiliation: Department of Internal Medicine, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania ; 1st Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: T
authors.initials: T
authors.lastname: Tiron
authors.affiliation: Department of Nephrology and Dialysis, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania ; 3rd Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: F
authors.initials: F
authors.lastname: Turcu
authors.affiliation: Department of Internal Medicine, "Sf. Ioan" Clinical Emergency Hospital Bucharest, Romania ; 1st Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: G
authors.initials: G
authors.lastname: Aron
authors.affiliation: 3rd Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Ciocâlteu
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000000981:diagnostic imaging; D012307:Risk Factors; D013977:Tibia / Q000098:blood supply; D061205:Vascular Calcification / Q000150:complications
keywords: angiography; asymptomatic coronary artery disease; hemodialysis; vascular calcification