Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2011  |  Volume : 22  |  Issue : 1  |  Page : 142--145

Breast calcifications in women with end-stage renal disease on maintenance hemodialysis


V Sivakumar1, Ch. Shoba Rani1, AY Lakshmi2, B Vijaya Lakshmi2,  
1 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India
2 Department of Radiology and Imaging, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India

Correspondence Address:
V Sivakumar
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh
India




How to cite this article:
Sivakumar V, Rani C, Lakshmi A Y, Lakshmi B V. Breast calcifications in women with end-stage renal disease on maintenance hemodialysis.Saudi J Kidney Dis Transpl 2011;22:142-145


How to cite this URL:
Sivakumar V, Rani C, Lakshmi A Y, Lakshmi B V. Breast calcifications in women with end-stage renal disease on maintenance hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2020 Jul 14 ];22:142-145
Available from: http://www.sjkdt.org/text.asp?2011/22/1/142/74387


Full Text

To the Editor,

Breast tissue calcifications on mammography in patients with end-stage renal disease (ESRD) on maintenance dialysis is gaining importance as an observation for further evaluation. Re­cently, breast calcifications were described and categorized according to The American College of Radiology Breast Imaging Reporting and Data System (BIRADS), which helped in cate­gorizing the benign from the malignant. We report our experience of breast calcifications in ESRD patients on maintenance hemodialysis (MHD) in this study.

During the period of 2006-7, out of 15 wo­men undergoing MHD for ESRD, 10 women agreed to undergo screening mammography. Mammograms were obtained by using a stan­dard four-view examination with the help of the Mammomat (Siemens). The mammograms were analyzed independently by two radiolo­gists showing attention on the type, quantity and distribution of breast calcification. The calcifications were described, categorized and reported according to the American College BIRADS. The mean age of the patients was 48.1 years (age range, 38-60 years). Chronic renal failure was due to diabetic nephropathy in 50%, hypertensive nephropathy in 30% and chronic glomerulonephritis in 20% of the pa­tients. All the patients were on thrice-weekly, 4-hourly HD. The mean duration of the dia­lysis support was 3.1 years (range, 1-8 years). The results are summarized in [Table 1].{Table 1}

Mammography revealed vascular type of calcifications belonging to the Benign Association Category of BIRADS in six out of the 10 pa­tients (60%), and they were noted in both the breasts in all six [Figure 1] and [Figure 2]. One patient showed presence of coarse calcifications in addition to vascular calcifications. The plasma calcium and phosphate product was below 55 mg 2 /dL 2 in all the patients. Plasma PTH esti­mation was performed in seven out of 10 pa­tients, and it was above 150 pg/mL in four pa­tients. Plasma 25 (OH) Vitamin D estimation was carried out in six out of 10 patients, and it was below 30 ng/mL in five patients [Table 1].{Figure 1}{Figure 2}

Since the advent of maintenance dialysis for chronic renal failure, metastatic calcification has been observed in a wide variety of tissues and organs. Disturbed calcium-phosphate metabo­lism, secondary hyperparathyroidism and Vita­min D deficiency contribute to metastatic cal­cification. [2],[3] The common sites of involvement in order of frequency are media of arteries, cor­nea and conjunctiva of the eye, para-articular soft tissues, skin and subcutaneous tissues and various visceral organs, including the lungs and heart. [2],[3] Breast calcification in patients with renal disease has been sparsely studied. Malig­nancy is found to be more common in patients with chronic renal failure, and this includes an increased incidence of ductal carcinoma of the breast. [4] Patterns of breast calcifications in re­nal dialysis are of interest because of the possi­bility that they may simulate malignancy. There­fore, it is recommended that every female pa­tient on dialysis therapy should be referred for screening mammography. Mammography is an important screening tool and should be offered to all dialysis patients according to standard healthcare guidelines of the general population. [1]

Breast calcifications were earlier classified into four groups: vascular, parenchymal, ductal and miscellaneous using Taber's description. [4],[5] Recently, the calcifications are described and categorized according to the American College of Radiology BIRADS. On mammography using this system, breast calcifications can be grouped under three categories: benign association, ma­lignant association and indeterminate associa­tion. [1]

Coarse calcifications belonging to indeterminate association were noted in one patient (10%), who also had vascular calcification in addition. In view of the indeterminate nature, she was advised further evaluation to exclude malignancy, which she denied. Our observa­tion of the presence of vascular calcifications in over 60% correlate with the earlier observa­tions of Evans et al, [4] Somers et al [5] and Mario Castellanos et al. [1] The calcium phosphate pro­duct was below 55 mg 2 /dL 2 in all the patients who had breast calcifications.

In conclusion, our study showed a prevalence of breast calcifications in 60% of the female patients on MHD, and all of them were vas­cular in type belonging to the benign associa­tion category of BIRADS. We did not find an elevated calcium phosphate product in any of them, which may be due to the fact that they were all on thrice-weekly MHD. It may not be prudent on our part to relate vitamin D def­ciency and elevated PTH levels with occur­rence of breast calcifications in our subjects as our data is small. However, the presence of the indeterminate category of calcifications in one of the 10 patients would justify the suggestion expressed in the literature that mammography screening should be offered to all the women on dialysis according to standard healthcare guidelines of the general population.

References

1Castellanos M, Verma S, Ahern K, et al. In­creased breast calcifications in women with ESRD on dialysis: Implications for breast cancer screening. Am J Kidney Dis 2006;48: 301-6.
2Han SY, Witten DM. Diffuse calcification of the breast in chronic renal failure. AJR Am J Roentgenol 1977;129:341-2.
3Evans SE, Whitehouse GH. Extensive calcifi­cation in the breast in chronic renal failure. Br J Radiol 1991;64:757-9.
4Evans AJ, Cohen ME, Cohen GF. Patterns of breast calcification in patients on renal dia­lysis. Clin Radiol 1992;45:343-4.
5Sommer G, Kopsa H, Xazgornik J, Salomo­nowitz E. Breast calcifications in renal hyper­parathyroidism. AJR Am J Roentgenol 1987; 148:855-7.