[Metastatic pulmonary calcification in patients with chronic renal insufficiency]

Case reports on two patients with metastatic pulmonary calcification are presented. Both suffered from long standing chronic renal failure and received immunosuppressive therapy for a (non-functioning) renal transplant. Laboratory tests disclosed hyperphosphatemia and secondary hyperparathyroidism. In the first patient, who presented with "pulmonary edema", the course was rapidly fatal. Diffuse pulmonary calcification was diagnosed only post mortem. Transbronchial biopsy was diagnostic for calcification in the second patient, who had exertional dyspnea and bilateral, asymmetric, interstitial infiltrations on chest X-ray. In patients with chronic renal failure, metastatic calcifications are due not only to disturbances of calcium-phosphate homeostasis but also to other, mostly unknown factors. Diagnostic procedures include biopsy and 99m-technetium-diphosphonate scintigraphy. Prophylaxis of pulmonary calcifications through normalization of serum phosphate and, if indicated, subtotal parathyroidectomy is of the utmost importance as regression of established calcifications rarely occurs.