Clinical Investigation

Kidney International (1973) 4, 229–235; doi:10.1038/ki.1973.104

Nature of soft tissue calcification in uremia

Sebastian R Contiguglia, Allen C Alfrey, Nancy L Miller, Donald E Runnells and Racquel Z Le Geros

Department of Medicine, Veterans Administration Hospital and University of Colorado Medical School Denver, Colorado, Department of Geological Sciences, University of Colorado, Boulder, Colorado, and the New York University Dental Center

Correspondence: Dr Allen C Alfrey, Veterans Administration Hospital, 1055 Clermont Street, Denver, Colorado 80220, U.S.A.

Received 8 January 1973; Revised 7 May 1973.

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Abstract

Nature of soft tissue calcification in uremia. The chemical and crystalline composition of metastatic calcification was studied in 21 uremic patients. Nonvisceral calcification has a calcium/magnesium/phosphorus (Ca:Mg:P) molar ratio of 30/1/18 and an apatitic x-ray diffraction pattern. The molar ratio of Ca/Mg/P in 33 tissue specimens (heart, lung and skeletal muscle) with calcification obtained from 19 uremic patients was 4.9/1/4.6, and x-ray diffraction showed only an amorphous pattern. Following incineration at 500°C, the diffraction pattern of magnesium whitlockite (CaMg)3(PO4)2 was found. This study demonstrates two distinct forms of calcium phosphate deposits in uremic patients. Nonvisceral and arterial calcification are hydroxyapatite. Calcification in heart, lung and skeletal muscle is an amorphous or microcrystalline compound composed of Ca/Mg/P in a constant molar ratio and is somewhat like whitlockite. The different tissue response incited by these two compounds is probably related to the larger crystal size found in nonvisceral calcification.

Nature des calcifications des tissus mous au cours de l'urémie. La composition chimique et cristalline des calcifications métastatiques a été étudiée chez 21 malades atteints d'urémie. Les calcifications non viscérales ont un rapport molaire Ca:Mg:P de 30:1:18 et un spectre apatitique de diffraction des rayons X. Le rapport molaire Ca:Mg:P dans 33 échantillons de tissus (co eligur, poumon et muscle squelettique) calcifiés provenant de 19 malades urémiques est de 4,9:1:4,6 et la diffraction des rayons X montre une structure amorphe. Après incinération à 500°C le spectre de diffraction du (Ca, Mg)3(PO4)2 est obtenu. Ce travail met en évidence deux formes distinctes de dépôts de phosphate de calcium chez les malades urémiques. Les calcifications extra-viscérales et artérielles sont de l'hydroxyapatite. Les calcifications du co eligur du poumon et du muscle squelettique sont un composé amorphe ou microcristallin de calcium-magnésium-phosphate dans un rapport molaire constant et semblable au (Ca, Mg)3(PO4)2. Les différences de la réponse tissulaire induite par les deux types de composés est probablement liée à la taille plus grande des cristaux trouvés dans les calcifications non viscérales.

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