Natural progression of calciphylaxis in a patient on haemodialysis

A 40 year old patient with end-stage renal disease developed features of calciphylaxis and tumoral calcification after four and half years on regular haemodialysis. The patient had hyperphosphatemia, with high calcium-phosphate index and radiological evidence of hyperparathyroidism before the onset of symptoms. Conservative management was without success and the patient developed florid symptoms. Parathyroidectomy was delayed due to unavoidable circumstances. When it was eventually performed there was a prompt regression of the calcific masses, but not of the vascular calcifications. The natural progression of the disease and its regression by parathyroidectomy provides an interesting insight into this phenomenon, the full blown picture of which is rarely seen these days.