Synoviale Manifestation der kalzifizierten urämischen Arteriolopathie bei Hyperparathyreoidismus

Abstract Calcific uraemic arteriolopathy occurs in about 1 % of patients with "endstage kidney". Skin ulcerations accompanying necroses of the subcutaneous adipose tissue are the hallmark of the disease. In some instances the skeletal musculature is involved; manifestations in the synovial tissue are hitherto undescribed. The 1960 borne male patient suffered from endstage kidney due to IgA-glomerulonephritis treated by dialysis since 1990. 1997 secondary hyperparathyroidism was treated with parathyroidectomy and subcutaneous reimplantation of parathyroid tissue. In 1998 allogeneic renal transplantation was performed. In the last three years persistent hyperparathyroidism was accompanied by pain and swelling of knee and ankle joints. Therefore, surgical synovectomy of the knee joint was performed; histologically the operation specimen contained neither amyloid nor inflammatory infiltrates. The main histological finding was calcification of small vessels with advanced narrowing of the lumina. From ultrastructural findings, x-ray microanalysis and pH-dependent solubility of the calcified material in the blood vessels it is assumed that the morphological changes were due to hyperparathyroidism and not to atherosclerosis. From the observations it is concluded that despite parathormone induced bone resorption and eventually osteoarthrosis or calcium pyrophosphate depositions articular pain in patients with uraemia may be evoked by calcification of synovial vessels. In addition, this case shows that tenderness and swelling of joints may be caused by noninflammatory mechanisms.