1
|
Lelii M, Senatore L, Paglialonga F, Consolo S, Montini G, Rocchi A, Marchisio P, Patria MF. Respiratory complications and sleep disorders in children with chronic kidney disease: A correlation often underestimated. Paediatr Respir Rev 2023; 45:16-22. [PMID: 35534343 DOI: 10.1016/j.prrv.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Chronic Kidney Disease (CKD) is characterized by a progressive and irreversible loss of kidney function which gradually leads to end-stage kidney disease (ESKD). Virtually all the organs are damaged by the toxicity of uremic compounds. The lungs may be affected and the impaired pulmonary function may be the direct result of fluid retention and metabolic, endocrine and cardiovascular alterations, as well as systemic activation of the inflammation. An increased prevalence in sleep disorders (SD) is also reported in patients with CKD, leading to a further negative impact on overall health and quality of life. While these complex relationships are well documented in the adult population, these aspects remain relatively little investigated in children. The aim of this review is to provide a brief overview of the pathophysiology between lung and kidney and to summarize how CKD may affect respiratory function and sleep in children.
Collapse
Affiliation(s)
- M Lelii
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy.
| | - L Senatore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy
| | - F Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy.
| | - S Consolo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy.
| | - G Montini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - A Rocchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, via della Commenda 9, 20122 Milan, Italy.
| | - P Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - M F Patria
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy.
| |
Collapse
|
2
|
Stârcea M, Gavrilovici C, Elsayed A, Munteanu M, Lupu VV, Cojocaru E, Miron I, Miron L. A case report of pediatric calciphylaxis-a rare and potentially fatal under diagnosed condition. Medicine (Baltimore) 2018; 97:e11300. [PMID: 29979398 PMCID: PMC6076114 DOI: 10.1097/md.0000000000011300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Though to be rare, calcific uremic arteriolophathy (CUA) is an ectopic calcification entity causing pain and disabilities in patients with chronic renal insufficiency, thus increasing the morbidity and mortality. PATIENT CONCERN We report a case of four years old boy admitted with acute respiratory failure. Physical examination revealed: irritability, purple subcutaneous hard nodules, tachypnea, dry spasmodic cough, respiratory rate 45/min, heart rate 110/min, blood pressure 100/60 mmHg, with normal heart sounds, no murmurs, hepatomegaly with hepato-jugular reflux. He was diagnosed at 2 years old with stage 5 chronic kidney disease due to untreated posterior urethral valve, and subsequently started peritoneal dialysis. He developed severe renal osteodystrophy, refractory to standard phosphate binders. DIAGNOSES Pathology examination revealed the presence of diffuse calcifications involving the skin, brain, heart, lung, kidney, stomach and pancreas, consistent with the underlying diagnosis of CUA. INTERVENTION Apart from standard treatment for end stage renal disease and associated co-morbidities, intensive care procedures have been initiated: oxygen therapy, continuous positive airway pressure, inotropic medication (Dopamine, Dobutamine), anticonvulsants (Diazepam), and antiedematous therapy (Dexamethasone). OUTCOME His pulmonary function rapidly deteriorated up to the severe hypoxemia, seizures and cardio-respiratory arrest, despite the initiation of intensive care measures. LESSONS A careful follow up of small children might detect in time an abnormal urinary pattern. The diagnosis of growth failure should also trigger urgent further investigation.
Collapse
Affiliation(s)
| | | | - Andra Elsayed
- Sf Maria Emergency Hospital for Children Iasi, Department of Pediatric Nephrology, Romania
| | - Mihaela Munteanu
- Sf Maria Emergency Hospital for Children Iasi, Department of Pediatric Nephrology, Romania
| | | | - Elena Cojocaru
- University of Medicine and Pharmacy Grigore T. Popa Iasi
| | - Ingrith Miron
- University of Medicine and Pharmacy Grigore T. Popa Iasi
| | - Lucian Miron
- University of Medicine and Pharmacy Grigore T. Popa Iasi
| |
Collapse
|
3
|
Gadre S, Kotloff RM. Noninfectious Pulmonary Complications of Liver, Heart, and Kidney Transplantation: An Update. Clin Chest Med 2017; 38:741-749. [PMID: 29128022 DOI: 10.1016/j.ccm.2017.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite significant advances in surgical techniques, perioperative care, and immunosuppressive therapy, solid organ transplantation still carries considerable risk of complications. Pulmonary complications, in particular, are a major cause of morbidity and mortality. Although infectious complications prevail, the lungs are also vulnerable to a variety of noninfectious complications related to the transplant surgery and adverse effects of the immunosuppressive regimen. This article focuses on noninfectious pulmonary complications associated with the 3 most commonly performed solid organ transplant procedures: liver, kidney, and heart.
Collapse
Affiliation(s)
- Shruti Gadre
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Robert M Kotloff
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
4
|
Ando T, Mochizuki Y, Iwata T, Nishikido M, Shimazaki T, Furumoto A, Minami S, Kinoshita N, Kawakami A. Aggressive pulmonary calcification developed after living donor kidney transplantation in a patient with primary hyperparathyroidism. Transplant Proc 2013; 45:2825-30. [PMID: 24034059 DOI: 10.1016/j.transproceed.2013.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/09/2012] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
Abstract
Metastatic pulmonary calcification, defined as calcium deposition in the intact lung, is commonly seen in patients with chronic renal failure, and it is known to be a benign clinical condition when detected by chance in an asymptomatic patient. Here we report the case of a 33-year-old woman who developed rapid and aggressive metastatic pulmonary calcification shortly after a living donor kidney transplantation, which induced acute antibody-mediated rejection. The patient's metastatic pulmonary calcification was successfully improved by extensive treatment for graft rejection, the correction of her accompanying primary hyperparathyroidism, and medical treatment with a bisphosphonate and sodium thiosulfate. Aggressive pulmonary calcification is reported as a rare complication seen in patients who have undergone a failed renal transplantation. A failed renal graft and accompanying secondary hyperparathyroidism seem to accelerate metastatic calcification. Most of the patients who develop aggressive pulmonary calcification suffer from the rapid progression of dyspnea and occasionally fever, and they die of respiratory failure. Pulmonary calcification should be considered in a patient developing dyspnea and unexplained pulmonary infiltrate, especially in the context of renal graft rejection; otherwise the prognosis of the patient will be very poor.
Collapse
Affiliation(s)
- T Ando
- First Department of Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Nagasaki, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
THURLEY PD, DUERDEN R, ROE S, POINTON K. Rapidly progressive metastatic pulmonary calcification: evolution of changes on CT. Br J Radiol 2009; 82:e155-9. [DOI: 10.1259/bjr/87606661] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
6
|
Weaver OO, Stazzone MM, Bhalla S. Progressive pulmonary calcification in a child after orthotopic liver transplantation. Pediatr Radiol 2006; 36:546-51. [PMID: 16568296 DOI: 10.1007/s00247-006-0132-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 01/31/2006] [Accepted: 02/06/2006] [Indexed: 10/24/2022]
Abstract
We present a case of progressive pulmonary calcification associated with prolonged respiratory insufficiency in a 2-year-old boy with a history of orthotopic liver transplantation. This case demonstrates the potentially progressive nature of pulmonary calcification and that it can present with respiratory insufficiency at a later period after transplantation than previously thought. We describe radiological findings and discuss established as well as plausible pathological mechanisms contributing to the development of calcifications in these patients.
Collapse
Affiliation(s)
- Olena O Weaver
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | | | | |
Collapse
|
7
|
Davenport A. Sudden onset of adult respiratory distress syndrome (ARDS) in a long standing chronic haemodialysis patient with lung calcification. Nephrol Dial Transplant 2006; 21:807-10. [PMID: 16410270 DOI: 10.1093/ndt/gfk040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Davenport
- University College London Center for Nephrology, Royal Free Hospital, London NW3 2QG.
| |
Collapse
|
8
|
Friedman JS, Fulghum Walters R, Woosley J, Fine JD. A unique presentation of calcinosis cutis in a patient with cystic fibrosis after double lung transplants. J Am Acad Dermatol 2003; 49:1131-6. [PMID: 14639400 DOI: 10.1016/s0190-9622(03)00874-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Calcinosis cutis is the deposition of insoluble calcium salts in the skin and subcutaneous tissue. We report the case of a 28-year-old Caucasian woman with cystic fibrosis in whom strikingly symmetrical and reticulate calcinosis cutis developed on the lower extremities, which was noted on histology to spare the eccrine glands. Careful review of the literature fails to reveal any previous report with these remarkable cutaneous and histologic manifestations.
Collapse
Affiliation(s)
- Jared Samuel Friedman
- Department of Dermatology, Schools of Medicine and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | |
Collapse
|
9
|
Chan ED, Morales DV, Welsh CH, McDermott MT, Schwarz MI. Calcium deposition with or without bone formation in the lung. Am J Respir Crit Care Med 2002; 165:1654-69. [PMID: 12070068 DOI: 10.1164/rccm.2108054] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary calcification and ossification occurs with a number of systemic and pulmonary conditions. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. Pathophysiologic states predisposing to pulmonary calcification and ossification include hypercalcemia, a local alkaline environment, and previous lung injury. Factors such as enhanced alkaline phosphatase activity, active angiogenesis, and mitogenic effects of growth factors may also contribute. The clinical classification of pulmonary calcification includes both metastatic calcification, in which calcium deposits in previously normal lung or dystrophic calcification, which occurs in previously injured lung. Pulmonary ossification can be idiopathic or can result from a variety of underlying pulmonary, cardiac, or extracardiopulmonary disorders. The diagnosis of pulmonary calcification and ossification requires various imaging techniques, including chest radiography, computed tomographic scanning, and bone scintigraphy. Interpretation of the presence of and the specific pattern of calcification or ossification may obviate the need for invasive biopsy. In this review, specific conditions causing pulmonary calcification or ossification that may impact diagnostic and treatment decisions are highlighted. These include metastatic calcification caused by chronic renal failure and orthotopic liver transplantation, dystrophic calcification caused by granulomatous disorders, DNA viruses, parasitic infections, pulmonary amyloidosis, vascular calcification, the idiopathic disorder pulmonary alveolar microlithiasis, and various forms of pulmonary ossification.
Collapse
Affiliation(s)
- Edward D Chan
- Division of Pulmonary Sciences, University of Colorado Health Sciences Center, Denver, USA.
| | | | | | | | | |
Collapse
|
10
|
Rabe J, Schnülle P, Diehl SJ, Lorenz D, van Der Woude FJ, Georgi M. Unclear radiographic pulmonary changes in a patient who recently underwent renal transplantation. Nephrol Dial Transplant 2001; 16:1490-2. [PMID: 11427648 DOI: 10.1093/ndt/16.7.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Rabe
- Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer, Mannheim, Germany
| | | | | | | | | | | |
Collapse
|
11
|
Affiliation(s)
- D N Kerr
- Royal College of Physicians of London, U.K
| |
Collapse
|
12
|
Crook M, Swaminathan R. Disorders of plasma phosphate and indications for its measurement. Ann Clin Biochem 1996; 33 ( Pt 5):376-96. [PMID: 8888972 DOI: 10.1177/000456329603300502] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M Crook
- Department of Chemical Pathology, Guy's Hospital, London, UK
| | | |
Collapse
|
13
|
Milliner DS, Zinsmeister AR, Lieberman E, Landing B. Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 1990; 38:931-6. [PMID: 2266678 DOI: 10.1038/ki.1990.293] [Citation(s) in RCA: 227] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Soft tissue calcification is a recognized complication of uremia in adult patients and has been implicated as a cause of ischemic necrosis, cardiac arrhythmias, and respiratory failure. However, soft tissue calcification has been regarded as rare in pediatric renal patients. Following a sudden death due to pulmonary calcinosis in an adolescent after renal transplantation, we retrospectively reviewed clinical, biochemical and autopsy data of 120 patients with uremia, on dialysis, or following renal transplantation cared for at Childrens Hospital of Los Angeles from 1960 to 1983. Soft tissue calcification was found in 72 of 120 patients (60 percent). Forty-three patients (36 percent) had systemic calcinosis (Group A): the most frequent sites of mineral deposition were blood vessels, lung, kidney, myocardium, coronary artery, central nervous system, and gastric mucosa. Vascular calcification was uniformly accompanied by deposits in other organs. Twenty-nine patients had small amounts of focal calcification (Group B) and 48 patients had no soft tissue calcification (Group C). By multiple logistic regression analysis, the use of vitamin D or its analogues, the form of vitamin D medication prescribed, the peak calcium x phosphorus product, the age at onset of renal failure, and male sex were jointly associated with calcinosis (Group A). Vitamin D therapy showed the strongest independent association with calcinosis and the probability of calcinosis was greater in patients receiving calcitriol when compared with dihydrotachysterol and vitamin D2 or D3. The duration of renal failure, peak serum calcium, serum calcium at death, serum phosphorus at death, and primary renal diagnosis, were not statistically associated with calcinosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- D S Milliner
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | | | | | | |
Collapse
|
14
|
Sinniah D, Landing BH, Siegel SE, Laug WE, Gwinn JL. Pulmonary alveolar septal calcinosis causing progressive respiratory failure in acute lymphoblastic leukemia in childhood. PEDIATRIC PATHOLOGY 1986; 6:439-48. [PMID: 3473456 DOI: 10.3109/15513818609041558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A syndrome of pulmonary alveolar septal calcinosis, pneumothorax, and pneumomediastinum, leading to rapidly progressive acute respiratory insufficiency and death was observed in 2 children with acute lymphoblastic leukemia (ALL). Primary clinical and radiological considerations in these patients were pulmonary edema and infection, and the diagnosis of pulmonary alveolar septal calcification was established only at autopsy. One patient, a 15-year-old girl, was found also to have parathyroid hyperplasia typical of familial hyperparathyroidism. The other, a 16-month-old girl, showed osteitis fibrosa of the bones and parathyroid hyperplasia of secondary type, suggesting that the pulmonary calcinosis resulted from hypercalcemia caused by a parathormone or prostaglandin-secreting tumor. The cause of pneumothorax and pneumomediastinum may have been rupture of calcified alveolar septa induced by high PEEP during ventilation of these patients. Other possible mechanisms contributing to hypercalcemia and pulmonary calcinosis in children with acute leukemia include bone resorption due to marrow infiltration, immobilization syndrome, renal failure, and administration of calcium, phosphate, or bicarbonate. This complication of acute leukemia in childhood is rare (2 patients in 430 autopsied over the period 1961-1982 at Childrens Hospital of Los Angeles). How often the process can be reversed if diagnosed before severe respiratory insufficiency is present is not known.
Collapse
|