Arterial calcifications of the hand: normal aging and the course in chronic dialysis patients

Normally, arterial calcifications in the hand progress from proximal to distal and do not reach the fingers by the 8th decade. In patients on maintenance dialysis arterial calcifications begin earlier and do not progress with age. The most severe arterial calcifications occur in patients with renal failure caused by diabetic nephropathy. Prognostically arterial calcifications in the finger-metacarpal region are an unfavourable sign.     

Unusual complication of soft tissue calcifications in chronic renal disease: The articular erosions

A rare complication, articular bone erosions adjacent to peri-articular calcifications, was observed in patients undergoing chronic haemodialysis. Three cases are described and the discussion describes the pathogenesis of the lesion, which, as far as is known by the authors, has not yet been reported in the literature.     

Morphology, progression, and regression of arterial and periarterial calcifications in patients with end-stage renal disease

The appearance of arterial calcifications over time was studied radiographically in 143 patients with end-stage renal disease. Of these, 85 patients had only slight calcifications; 58 had the well-known, linear, pipe stem-like arterial calcifications. In 44 of the 58, small nodular calcifications were noted, often external to the linear calcifications. Nine patients had larger periarterial calcifications, which have not been previously described to our knowledge. Arterial calcifications progressed in 82 of 143 patients (57%) and regressed in 19 (13%). During progression, thickening of the linear calcifications was often observed, and in ten patients this caused definite luminal narrowing. From 1976 to 1984, five of 71 patients (7%) required amputations; all five had marked arterial calcifications. Better controlled clinical studies are indicated to detect factors that may prevent the progression and promote the regression of arterial calcifications.     

Coccidioidomycosis in renal dialysis and transplant patients: radiologic findings in 30 patients

Asymptomatic primary coccidioidal infection is common. After the initial infection is contained, the organism can remain dormant in the body for years. Immunosuppression related to renal transplantation or dialysis may reactivate dormant disease. Thus, symptomatic disease may be seen in those with no known history of previous coccidioidomycosis who have visited endemic areas only briefly. To determine if coccidioidomycosis produces characteristic radiographic findings in renal transplant and dialysis patients, we reviewed the records and radiographs of all patients in either of these two categories who are known to have developed active coccidioidal infection in southern Arizona since 1965. Thirty patients (12 undergoing dialysis and 18 transplant recipients) were identified. We conclude that the radiographic manifestations of pulmonary coccidioidomycosis in renal transplant and dialysis patients are highly variable. Interstitial and alveolar patterns of disease are equally likely to occur. Extrathoracic infection without evidence of pulmonary disease occurred in 11 patients (37%), but was radiographically demonstrable only as septic arthritis or perinephric abscess.     

Arterial calcifications seen on mammograms: cardiovascular risk factors, pregnancy, and lactation

PURPOSE: To retrospectively assess if mammographic calcium deposits are related to coronary heart disease (CHD) risk factors and reproductive factors in a subset of women participating in the European Prospective Investigation into Cancer and Nutrition study. MATERIALS AND METHODS: The study was approved by the institutional review board of the University Medical Center Utrecht; informed consent was obtained. Mammograms were evaluated by two radiologists for the presence of breast arterial calcifications (BAC) in the Prospect cohort, a breast cancer screening population of women aged 49-70 years (mean, 57 years) within the European Prospective Investigation into Cancer and Nutrition study. Cardiovascular risk factors and reproductive factors were examined for independent effects on the prevalence of BAC. Logistic regression analysis was performed. RESULTS: BAC was present in 194 of 1699 (11%) women and increased with age to 20% in the highest quartile of age (mean, 66 years). The odds ratio was 4.7 in the highest versus the lowest quartile of age (95% confidence interval [CI], 2.9, 7.6). After adjustment for age, no significant association was found between BAC and traditional cardiovascular risk factors. Current smoking was inversely related to BAC (odds ratio, 0.6; 95% CI: 0.4, 0.9). BAC was prevalent in 2.5% of nulliparous women, in 9% of women with one or two children, and in 17% of women with three or more children (odds ratio, 7.2; 95% CI: 2.9, 18.0). Breast feeding after pregnancy was significantly associated with BAC in women who ever were pregnant (odds ratio, 2.2; 95% CI: 1.4, 3.6). CONCLUSION: Calcifications in arteries on mammograms are associated with increasing age, pregnancy, and lactation but not with various cardiovascular risk factors.     

Urothelial microvascular response to chronic renal inflammatory disease

Renal pelvocaliceal mucosal opacification has been observed clinically in patients with inflammatory disease. We studied the microvascular changes that might be responsible for this finding using barium injection and microradiographic studies of 20 human kidneys excised due to infection. There were six patients with staghorn calculi and chronic pyelonephritis, four with pyohydronephrosis, eight with acute and chronic pyelonephritis, and two with xanthogranulomatous pyelonephritis. The microangiograms correlated with severity of inflammation. In mild cases, slight vessel hypertrophy involved the terminal arterioles and arteries supplying the urothelium. In severe cases, there was marked neovascularity with feeding vessel hypertrophy and mucosal thickening. Our studies demonstrate that abnormal pelvocaliceal vascularity is responsible for the findings seen on urography and angiography of inflammatory disease.     

Urothelial microvascular response to chronic renal inflammatory disease

Renal pelvocaliceal mucosal opacification has been observed clinically in patients with inflammatory disease. We studied the microvascular changes that might be responsible for this finding using barium injection and microradiographic studies of 20 human kidneys excised due to infection. There were six patients with staghorn calculi and chronic pyelonephritis, four with pyohydronephrosis, eight with acute and chronic pyelonephritis, and two with xanthogranulomatous pyelonephritis. The microangiograms correlated with severity of inflammation. In mild cases, slight vessel hypertrophy involved the terminal arterioles and arteries supplying the urothelium. In severe cases, there was marked neovascularity with feeding vessel hypertrophy and mucosal thickening. Our studies demonstrate that abnormal pelvocaliceal vascularity is responsible for the findings seen on urography and angiography of inflammatory disease.     

The relationship between renal scarring and stone disease

The urographic findings of focal clubbing of the renal calices and associated parenchymal scarring usually prompt a diagnosis of chronic pyelonephritis, which is frequently thought to be due to ongoing or previous vesicoureteral reflux. However, we noticed that upper tract stone disease appeared to be the condition that most often preceded or accompanied caliceal clubbing and parenchymal scarring in adults. To test the hypothesis that stones were the most common cause of this renal abnormality, we analyzed the IV urograms in 1500 consecutive patients for evidence of upper tract stone disease, vesicoureteral reflux, and caliceal clubbing and scarring. Of 39 patients with clubbing and scarring, 67% had stone disease, but only 8% had a history of reflux. Of 90 patients with stone disease, 29% had clubbing and scarring. We conclude that, in adults, upper tract stone disease may be the most important etiologic factor in the production of renal caliceal clubbing and scarring.     

CT of acquired cystic kidney disease and renal tumors in long-term dialysis patients

The kidneys of long-term dialysis patients frequently demonstrate multiple small acquired cysts and renal cell tumors on pathologic examination. The original kidneys of 30 long-term dialysis patients and six renal transplant patients were evaluated by computed tomography to determine the incidence of these abnormalities. Among dialysis patients, 43.3% had diffuse bilateral cysts, while 16.7% had occasional cysts (fewer than five per kidney), and 40% showed no renal cysts. Seven solid renal tumors were detected in four dialysis patients with renal cysts. Acquired cystic kidney disease tends to result in renal enlargement, is more common in patients who have been maintained on dialysis for prolonged periods, and may lead to spontaneous renal hemorrhage. The six transplant patients showed no evidence of renal cysts, and all had markedly shrunken kidneys. Acquired cystic disease and renal cell tumors in the original kidneys of dialysis patients may be due to biologically active substances that are not cleared effectively by dialysis but that are removed by normally functioning transplant kidneys.     

Progress of brown tumors in patients with chronic renal insufficiency undergoing dialysis.

In a group of 73 patients, affected by chronic renal insufficiency, whose skeleton was periodically checked, three cases of brown tumors were found. These cases demonstrated a variety of locations that were involved, especially the pelvis, ribs and mandible. During therapeutic treatment the brown tumors presented a different behavior; while some lesions tended toward complete sclerosis, others increased in size and in both instances new lesions appeared. Parathyroidectomy, carried out in two patients, determined a definitive sclerosis of these lesions. Brown tumors also correlate with high PTH levels and with lesions from osteitis fibrosa.