Tendon Swelling After Kidney Transplantation
A 64-year-old man with IgA nephropathy who had received a donor kidney a long time ago complained of intermittent swelling of the right Achilles tendon and both wrists since 2011. The extremely painful swellings responded to prednisolone pulse therapy and persisted for 3 to 4 days. The episodes were sporadic at first but had become frequent in the past year, and recently prednisolone had brought about only slight improvement. The patient was known to have gout. Immune suppression was achieved with belatacept/mycophenolate and low-dose prednisolone. Uric acid, AP, Ca/phosphate, and CRP were normal, ANA and anti-CCP were negative. Parathormone was slightly elevated at 97 pg/ml (reference range: 15.6 to 65 ng/ml) with eGFR of 45 ml/min. Sonography revealed demarcated echodense structures, which projection radiography then identified as ectopic calcifications with a distinct depot around the Achilles tendon (Figure). The episodic swelling was therefore most likely an inflammatory soft-tissue reaction to these depots. The calcifications can be explained by hyperparathyroidism against the background of long-term chronic kidney disease and calcium pyrophosphate deposition. PTD-lowering treatment with vitamin D and cinacalcet was initiated.
Prof. Dr. med. Stefan Reuter, Medizinische Klinik D, Universitätsklinikum Münster, firstname.lastname@example.org
Dr. med. Philipp Backhaus, Klinik für Nuklearmedizin, Institut für klinische Radiologie, Universitätsklinikum Münster
Prof. Dr. med. Heidemarie Becker, Medizinische Klinik D, Universitätsklinikum Münster
Conflict of interest statement: The authors declare that no conflict of interest exists.
Cite this as: Reuter S, Backhaus P, Becker H: Tendon swelling after kidney transplantation.
Dtsch Arztebl Int 2018; 115: 595. DOI: 10.3238/arztebl.2018.0595
Translated from the original German by David Roseveare