Retinal calcification

Abstract: A 17-year-old boy with end-stage renal disease (ESRD) due to an unknown reason was admitted to our hospital with bone pain. He had been followed on continuous ambulatory peritoneal dialysis (CAPD) for 87 months in different centers. He had received erythropoietin, iron, antihypertensive drugs, calcitriol, and a calcium-containing phosphate binder previously, but we have learned that he had not taken his medication regularly in recent years. He was growth retarded and he had severe bone pain especially in his lower extremities. Physical examination revealed hypertension (170/110 mmHg) as well as pain and sensitivity on his shoulders, arms, hands, legs, and feet. Laboratory investigations were as follows: serum urea 382 mg/dl, creatinine 9.8 mg/dl, albumin 3.1 g/dl, calcium 10.6 mg/dl, inorganic phosphorus 8.6 mg/dl, calcium-phosphorus (CaxP) product 91.1 mg/dl, parathyroid hormone 589 pg/ml (normal: 9.5-75), C-reactive protein (CRP) 5.6 mg/dl (normal: 0–0.8), and erythrocyte sedimentation rate 85/h. Extraosseous calcifications in the abdominal aorta, iliac, radial, ulnar, posterior, and anterior tibial arteries and their distal branches, left coronary artery, mitral valve, and chorda tendinea were shown by radiological examination. A single calcification focus, next to the inferotemporal arteriolar branch of the central retinal artery in the midperipheral fundus of the left eye, without ischemic retinal changes, was detected in addition to stage I hypertensive retinopathy in his fundus examination (Fig. 1). He had transferred to hemodialysis with low dialysate calcium because of persistent ultrafiltration failure. The calcium-containing phosphate binder was changed to one containing aluminum hydroxide due to the lack of calcium-free phosphate binders. Metastatic calcifications of soft tissue, vascular bed including coronary arteries, and cardiac valves in pediatric patients with end-stage renal disease, on dialysis, and after renal transplantation have been previously described. The age at renal failure, gender, cumulative dialysis and endstage renal disease duration, elevated CaxP product, serum parathyroid hormone (PTH), type of vitamin D, CRP, and plasma homocysteine level were found to be associated with severity of calcinosis. Corneoconjunctival calcium deposits were reported as an ocular finding of chronic renal failure in adult and pediatric patients on hemodialysis. Retinal arteriolar calcification in patients with ESRD has rarely been reported. Improvement or attenuated progression of vascular calcification can be Pediatr Nephrol (2006) 21:1915–1916 DOI 10.1007/s00467-006-0200-9