We present a case demonstrating (1) the possibility of diagnosing metastatic calcification with respiratory failure occurring in acute renal failure using CT densitometry and bronchoalveolar lavage, and (2) its relatively rapid resolution with hydration after the return of renal function.
A 30 year old male was admitted with a cocaine/narcotic mixed overdose and diffuse burns. His laboratory studies revealed rhabdomyolysis with CPK levels in excess of 400, 000 IU, renal failure with a creatinine level of 6.0 mg/dl and a phosphate level of 7.3 mg/dl. He was removed from dialysis on hospital day 51. Subsequent to this he developed acute hypercalcemia with the attendant development of diffuse interstitial pulmonary infiltrates and acute hypoxemic respiratory failure.A gallium scan of the lungs showed diffuse uptake throughout both lung fields. Fiberoptic broncoscopy yielded BAL fluid containing calcium particles. The CT of the chest showed that the pixel densities of the interstitial infiltrates were consistent with calcification, and this was confirmed by nuclide bone scanning which demonstrated calcification in both lung fields. With further improvement of renal function and hydration, the patient’s infiltrates and oxygenation progressively improved, until on hospital day 135 he was removed from mechanical ventilation.DISCUSSION: Metastatic calcification of the lungs is a cause of interstitial lung disease in acute renal failure which can be diagnosed without lung biopsy utilizing minimally invasive and non-invasive methods. It can resolve spontaneously with improvement in renal function and conservative management.
In the setting of acute renal failure, especially with rhabdomyolysis, respiratory failure and acute interstitial lung disease can be evaluated with CT densitometry, nuclide scanning and BAL. If metastatic calcification of the lungs is identified, prolonged conservative therapy should be provided.
H.H. Hrachian, None.