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A 20-year-old man, who had long-standing end-stage renal disease and was receiving peritoneal dialysis, presented with fever and abdominal pain. The patient began peritoneal dialysis at the age of 4 years because of a nephropathy of uncertain origin and subsequently underwent a renal transplantation, which failed. He had hypertension, had had multiple previous episodes of peritonitis, and had undergone a partial parathyroidectomy. Extensive calcifications were noted on radiographic evaluation, including increased opacification of the pulmonary interstitium on chest radiography (Panel A), extensive calcification within the interstitium on computed tomography (CT) of the chest (Panel B), and extensive peritoneal calcifications on abdominal CT (Panel C). On admission, his serum calcium level was 8.4 mg per deciliter (2.1 mmol per liter; normal value, 8.8 to 10.2 mg per deciliter [2.2 to 2.6 mmol per liter]) and his phosphate level 8.3 mg per deciliter (2.7 mmol per liter; normal value, 2.5 to 4.5 mg per deciliter [0.8 to 1.5 mmol per liter]). Peritonitis was diagnosed and was successfully treated with antimicrobial agents. Treatment was subsequently changed to hemodialysis. Widespread, or metastatic, calcification is a common complication in patients receiving long-term dialysis. Despite the radiographic findings, the patient, according to digital pulse oximetry, had an oxygen saturation of 98% while breathing ambient air and walking.
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