Man of stone

A 53-year-old obese man developed abdominal pain after recently commencing haemodialysis. He had undergone a pre-emptive renal transplant 34 years prior for end-stage kidney disease due to renal hypoplasia. Examination found a hard and tender abdominal apron. Biochemistry showed a corrected calcium of 2.83 mmol/L (2.15–2.60), phosphate of 1.56 mmol/L (0.81–1.45) and parathyroid hormone of 29.5 pmol/L (1–7). His calcium and phosphate had been within the normal reference range until commencing haemodialysis.

CT (figure 1) revealed extensive dystrophic subcutaneous calcification, opacification within the stomach and bowel (arrow A) from ingestion of the phosphate binder lanthanum, vascular calcification (arrow B), renal transplant (arrow C) and hypoplastic native kidneys (arrow D). Skin punch biopsy (figure 2) stained with H&E showed medial calcification of arterioles (arrow E) consistent with calcific uraemic arteriolopathy (CUA) or calciphylaxis.

Calciphylaxis was described in 1961 by Seley, who demonstrated in mice a two-step pathogenic process: (1) a ‘critical period’ where...

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