Laboratory Investigation

Kidney International (1980) 18, 95–102; doi:10.1038/ki.1980.114

Pulmonary calcification in hemodialyzed patients detected by technetium-99m diphosphonate scanning

Pierre F Faubert1, Warren B Shapiro1, Jerome G Porush1, Shyan-Yih Chou1, Joel M Gross1, Elliott Bondi1 and Guillermo Gomez-Leon1

1Division of Nephrology, Department of Medicine and Department of Pathology, The Brookdale Hospital Medical Center, Brooklyn, New York

Correspondence: Dr Jerome C Porush, Chief, Division of Nephrology, Brookdale Hospital Medical Center, Linden Boulevard at Brookdale Plaza, Brooklyn, New York 11212, USA

Received 23 August 1978; Revised 10 December 1979.

Top

Abstract

Pulmonary calcification in hemodialyzed patients detected by technetium-99m diphosphonate scanning. Metastatic pulmonary calcification, a well-known complication in patients with chronic renal disease, has been demonstrated postmortem in patients with a negative chest X-ray. Recently, scintigrams with bone-seeking radionuclides have been used to detect such subclinical pulmonary calcium deposits. We describe 23 patients on maintenance hemodialysis with no evidence of pulmonary calcification on chest X-ray who were prospectively studied by lung scanning with a bone-seeking radionuclide and pulmonary function testing. Of the 23 patients, 14 (61%) had a positive technetium-99m diphosphonate (99mTc-DP) scan (group 1). These patients were on dialysis 38 plusminus 5 months compared with 12 plusminus 4 months in 9 patients with a negative scan (group 2) (P < 0.01). Age, sex, blood pressure, hematocrit, serum calcium, phosphorous, bicarbonate, magnesium, and calcium times phosphorus product, as well as parathyroid hormone level did not differ between the two groups. Of 10 group-1 patients tested, 7 had abnormal pulmonary diffusion capacity compared with none in 5 group-2 patients tested (P = 0.014). Histologic examination of the lung in 1 group-1 patient who expired revealed calcification (amorphous on X-ray diffraction), whereas none was found in 1 group-2 patient autopsied. These observations suggest that in patients on maintenance hemodialysis, pulmonary scanning with 99mTc-DP is a sensitive method for detecting pulmonary metastatic calcification, which may be associated with an abnormality in pulmonary diffusion capacity.

Calcifications pulmonaires, chez les malades en hémodialyse, mises en évidence par la scintigraphie au diphosphonate tech-netium-99m. Les calcifications pulmonaires métastatiques, complication bien connue chez les malades en insuffisance rénale chronique, ont été mises en évidence post-mortem chez des malades dont la radiographie thoracique était normale. Plus récemment, des scintigraphies au moyen de radionuclides employés pour l'imagerie osseuse ont été utilisées pour détecter de tels dépôts pulmonaires latents de calcium. Ce travail décrit 23 malades en hémodialyse chronique sans signes radiologiques de calcifications pulmonaires qui ont été étudiés, de façon prospective, par scintigraphie pulmonaire et épreuves fonctionnelles respiratoires. Quatorze de ces 23 malades (61%) avaient une scintigraphie positive au diphosphonate technetium-99m (99mTc-DP) (groupe 1). Ces malades étaient en dialyse depuis 38 plusminus 5 mois alors que les 9 malades indemnes étaient traités depuis 12 plusminus 4 mois (groupe 2) (P < 0,01). L'âge, le sexe, la pression artérielle, l'hématocrite, la calcémie, la phosphorémie, les bicarbonates, la magnésémie, et le produit calcium times phosphore, de même que la concentration d'hormone parathyroïdienne, n'étaient pas différents entre les deux groupes. Sept parmi les 10 malades étudiés dans le groupe 1 avaient un abaissement de la capacité de diffusion qui était normale chez les 5 malades étudiés dans le groupe 2 (P = 0,014). L'examen histologique du poumon chez un malade décédé du groupe 1 a montré des calcifications (amorphes en diffraction des rayons X) alors qu'aucune n'a été observée chez un malade autopsié du groupe 2. Ces constatations suggèrent que chez les malades en hémodialyse la scintigraphie pulmonaire avec 99mTc-DP est une méthode sensible pour détecter les calcifications pulmonaires, lesquelles peuvent être associées à une anomalie de la capacité de diffusion alvéolo-capillaire.

Top

References

  1. Kaltreider HB, Baum GL, Bogaty G, McCoy MD, Tucker M: So-called "metastatic" calcification of the lung. Am J Med 46:188–196, 1969
  2. McLachlan MB, Wallace M, Seneviratne C: Pulmonary calcification in renal failure: Report of three cases. Br J Radiol 41:99–106, 1968
  3. Mootz JR, Sagel SS, Roberts TH: Roentgenograph manifestations of pulmonary calcifications. Diag Radiol 107:55–60, 1973
  4. Conger JD, Hammond WS, Alfrey AC, Contiguglia SR, Stanford RE, Huffer WE: Pulmonary calcification in chronic dialysis patients: Clinical and pathological studies. Ann Intern Med 83:330–336, 1975 | PubMed | ISI | ChemPort |
  5. Holms R: Detection of diffuse metastatic pulmonary calcification with radiostrantium. J Nucl Med 11:327–338, 1970
  6. Devacaanthan K, Yap AU, Chayes Z, Stein RM: Pulmonary calcification in chronic renal failure: Use of diphosphonate scintiscan as a diagnostic tool. Clin Nephrol 6:488–491, 1976
  7. Moinuddin M, Rockett JF, Weber A: Scanning for pulmonary calcification (letter). Ann Intern Med 84:224, 1976
  8. Davis BA, Poulose KP, Reba RC: Scanning for uremic pulmonary calcifications (letter). Ann Intern Med 85:132, 1976
  9. Rosenthal DI, Chandler HL, Azizi F, Schneider PB: Uptake of bone imaging agents by diffuse pulmonary metastatic calcification. Am J Roentgenol 129:871–874, 1977
  10. Coburn JW, Massry SG, Gordon S, Rubini ME: Spurious hypocalcemia in patients undergoing maintenance hemodialysis. Am J Clin Pathol 52:572–576, 1969
  11. Lindall AW, Wong ET: Column chromatography of human serum parathyroid immunoreactive peptides. Proc Soc Exp Biol Med 148:799–804, 1975
  12. Zikulka A, Despas PJ, Milic-Emili J, Anthonisen NR: Pulmonary function with acute loss of excess lung water by hemodialysis in patients with chronic uremia. Am J Med 55:134–141, 1973
  13. Bates DV, Macklem PT, Christie RV: Chapters 2 and 21 in Respiratory Function in Diseases (2nd ed), edited by Bates DV, Macklem PT, Christie RV, Philadelphia, W. B. Saunders Co., 1971, pp. 10–95 and 418–440
  14. Contiguglia SR, Alfrey AC, Miller NL, Runnells DE, LeGeros RZ: Nature of soft tissue calcification in uremia. Kidney Int 4:229–235, 1973 | PubMed | ISI | ChemPort |
  15. Kuzela DC, Huffer WE, Conger JD, Winter SD, Hammond WS: Soft tissue calcification in chronic dialysis patients. Am J Pathol 86:403–417, 1977 | PubMed | ISI | ChemPort |
  16. Gremes GM, Sausen DD, Jansen C, Soderblom RE, Hodgkin JE, Stilson MS: Radionuclide detection of diffuse interstitial pulmonary calcification. JAMA 230:992–995, 1974
  17. McLaughlin AF: Uptake of TC-99m bone scanning agent by lungs with metastatic calcification. J Nucl Med 16:322–323, 1975
  18. Richards AG: Metastatic calcification detected through scanning with 99mTc-polyphosphate. J Nucl Med 15:1057–1060, 1974
  19. Valentzas C, Meindok H, Oreopoulos DG, Meema HE, Rabinovich S, Sutton D, Ogilvie R: Detection and pathogenesis of visceral calcification in dialysis patients and patients with malignant disease. Can Med Assoc J 11:45–49, 1978
  20. de Graaf P, Schicht IM, Pauwels EKJ, Souverun JHM, de Graaf J: Bone scintigraphy in uremic pulmonary calcification. J Nucl Med 20:201–206, 1979
  21. Conger JD, Alfrey AC: In comment to the editor. Ann Intern Med 84:224–225, 1976
  22. Alfrey AC, Solomon CC, Cirillo J, Miller NL: Extraosseous calcification: Evidence for abnormal pyrophosphate metabolism in uremia. J Clin Invest 57:692–699, 1976 | PubMed | ISI | ChemPort |
  23. Alfrey AC, Solomons CC: Bone pyrophosphate in uremia and its association with extraosseous calcification. J Clin Invest 57:700–705, 1976 | PubMed | ISI | ChemPort |
  24. Akmal M, Goldstein DA, Telfer N, Wilkinson E, Massry SG: Resolution of muscle calcification in rhabdomyolysis and acute renal failure. Ann Intern Med 89:928–930, 1978
  25. Buja LM, Tofe AJ, Kulhami PV, Mukherjee A, Parkey RW, Francis MD, Bonte FJ, Willerson JT: Sites and mechanisms of localization of Technetium-99M phosphorus radiopharmaceuticals in acute myocardial infarcts and other tissues. J Clin Invest 60:724–740, 1977
  26. Rosenthal L, and Kaye M: Technetium-99M-pyrophos-phate kinetics and imaging in metabolic bone disease. J Nucl Med 16:33–39, 1975
  27. Kaye M, Silverton S, Rosenthall L: Technitium-99M-pyrophosphate: Studies in vivo and in vitro. J Nucl Med 16:40–45, 1975
  28. Kraikitpanitch S, Lindeman RD, Ynice AA, Baxter DJ, Haygood CC, Blue MM: Effect of azotemia on the myocardial accumulation of calcium. Mineral Electrolyte Metab 1:12–20, 1978
  29. Sy WM, Mittal AK: Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy. Br J Radiol 48:878–884, 1975
  30. Massry SG, Coburn JW: Divalent ion metabolism and renal osteodystrophy. Chapter 11, in Clinical Aspects of Uremia and Dialysis, edited by Massry SG, Sellers AL, Springfield, I11., Charles C Thomas, 1977, p. 304
  31. Alfrey AC, Jenkins D, Groth CG, Schorr WS, Gecelter L, Ogden DA: Resolution of hyperparathyroidism, renal osteodystrophy and metastatic calcification following renal homotransplantation. N Engl J Med 279:1349–1356, 1968 | PubMed |

Extra navigation

.
ADVERTISEMENT