Electron beam computed tomography of the heart before renal transplantation: Severe coronary artery disease in a 21-year-old female with nephrocalcinosis due to infantile hypercalcemia syndrome

Background: Cardiovascular diseases are very common in patients with end-st age renal disease and are the underlying cause of approximately half the de aths in dialysis patients. In those patients vascular calcifications are ty pically seen in the tunica media and therefore represent histopathological changes different to those ill atherosclerosis. For the evaluation of cardi ovascular risk in chronic dialysis patients, a method is needed to reliably identify patients who have to undergo invasive diagnostics. Coronary arter y calcium assessed by electron beam computed tomography (EBT) has been sugg ested to measure the extent of coronary atherosclerosis in patients with no rmal renal function. It might also be of value in the stratification of car diovascular risk in patients with renal failure. Case Report: We report the case of a 21-year-old female with end-stage rena l disease as a result of idiopathic infantile hypercalcemia with nephrocalc inosis and extensive vascular calcification. Due to a total atrioventricula r block, a 2-chamber pacemaker had been implanted in 1998. Because of a ver y high calcium score in EBT, depressed left ventricular function in echocar diography, and limited physical strength she was sent to coronary angiograp hy. Severe 2-vessel coronary artery disease was found and successfully trea ted by balloon angioplasty. She was then listed for renal transplantation. Angiographic 6-month follow-up showed an excellent long-term result. Conclusion: This case demonstrates that coronary artery disease can also be present in young dialysis patients. Discrimination of atherosclerotic vasc ular calcification and tunica media sclerosis typical in dialysis patients without hemodynamic effects is difficult. EBT allows for the direct detecti on of coronary calcium. Its extent correlates with coronary atherosclerosis and the probability of acute coronary syndromes in patients with normal re nal function. This evidence has not been proved for dialysis patients, yet. However, EBT may be of value in the stratification of cardiovascular risk for patients awaiting renal transplantation.