Pulmonary vascular calcification in a nocturnal hemodialysis patient

Although vascular calcification in end-stage renal disease (ESRD) is common, metastatic pulmonary calcification (MPC) is an under-recognized complication of ESRD with the majority of individuals being asymptomatic. Similar to calcification in other arterial vascular beds, elevated serum calcium and phosphate appear to be potent risk factors although the exact pathogenesis of MPC remains largely unclear. Nocturnal hemodialysis (NHD) is a form of renal replacement therapy that offers superior control of serum phosphate and uremia compared to conventional (3 times weekly) intermittent hemodialysis and shows promise in delaying the progression of vascular calcification. Here, we report the first case of MPC involving the pulmonary vasculature in a patient treated with nocturnal hemodialysis and discuss the epidemiology, pathogenesis, histology and natural history of MPC.