CRYSTAL-INDUCED INFLAMMATION ASSOCIATED WITH CHRONIC RENAL FAILURE TREATED WITH PERIODIC HEMODIALYSIS

Acute episodes of articular and periarticular inflammation occurred in a patient receiving periodic hemodialysis twice weekly for chronic renal failure. Musculoskeletal symptoms, articular in location, appeared prior to dialysis therapy. Further symptoms, mainly periarticular and para-articular in location, were observed after hemodialysis was begun and appeared to develop in association with metastatic calcification not previously noted. The upper extremities were primarily involved. Response to colchicine therapy was consistently good whether the attacks were articular or paraarticular in location. Analysis of soft tissue crystalline material by x-ray and electron diffraction technics revealed calcium apatite but no urates or pyrophosphates. Increase in dialysis time to three times a week was not associated with reduction of serum uric acid and phosphorus levels or with clinical improvement of musculoskeletal symptoms or significant reduction of tissue calcium deposition as observed on roentgenograms. Treatment with aluminum hydroxide gel resulted in a significant reduction of serum phosphorus levels with associated clinical and roentgenologic improvement even when dialysis time was reduced to a twice weekly schedule. Reduction of antacid therapy was promptly followed by increased symptoms and new areas of metastatic calcification. No specific relationship was noted between serum uric acid levels and the degree of clinical symptoms or metastatic calcifications. The clinical syndrome observed appeared to present features which were atypical for gout. The clinical course, crystal analysis and response to therapy suggest that inflammatory episodes in this syndrome following institution of periodic hemodialysis occur as a response to soft tissue calcifications which develop in relationship to dialysis therapy. © 1969.