Figure 1. Metastatic Calcification of the Shoulder in Chronic Renal Failure. A 32-year-old man with chronic renal failure (from IgA nephropathy) being treated with maintenance hemodialysis began to take his phosphate-binding medications irregularly, and swelling of the right shoulder developed over a period of two months. The calcium-phosphate product (in milligrams per deciliter) was more than 90, and the serum N-terminal parathyroid hormone level was elevated. A biopsy of the shoulder mass (arrow) revealed hydroxyapatite. The patient underwent subtotal parathyroidectomy and was referred for renal transplantation.
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