Pulmonary hypertension with extensive calcification in small pulmonary vessels and alveolar capillary wall in a chronic hemodialysis patient

Abstract

We report a case of a 41-year-old male with end-stage renal disease receiving chronic hemodialysis who was referred to this hospital because of dyspnea. He had been on a regular dialysis for 20 years due to chronic glomerulonephritis. His transthoracic echocardiography revealed severe pulmonary hypertension (PH), and cardiac catheterization confirmed this diagnosis. From clinical examination and review of the chest X-ray and computed tomography images, we thought PH was due to multifactorial mechanisms typical of hemodialysis patients. However, microscopic examination of lung tissue from autopsy specimen revealed extensive calcium deposits not only in alveolar septal wall but also in alveolar capillaries and small vessels, which had diffuse intimal thickening causing the narrowing of the lumens. These pathological findings suggest that pulmonary vascular calcification contributed to the PH in this patient.<Learning objective: Pulmonary hypertension (PH) is prevalent and associated with mortality in patients with end-stage renal disease (ESRD). However, the pathogenesis of PH with ESRD remains uncertain. Here we report a PH case receiving long-term hemodialysis, and whose pathological findings revealed extensive calcification in small pulmonary vessels and alveolar capillaries. This case will provide evidence indicating the causative role of pulmonary calcification for the development of PH in dialysis patients.>