PTH-I: immuno-reactive parathyroid hormone. Discussion Secondary hyperparathyroidism is a common and serious consequence of ESRD. Secondary hyperparathyroidism is characterized by parathyroid hyperplasia, persistently elevated parathyroid hormone (PTH) levels, and systemic mineral and bone abnormalities.6) Abnormal calcium and phosphate metabolism in ESRD is thought to account for the majority of heart structure Inhibitors,research,lifescience,medical calcification.7) The prevalence of such soft-tissue PI3K inhibitor calcification ranges from 11% to 81% of cases. Calcification of internal viscera such as

heart, lungs, stomach, and kidneys, however, is clinically more insidious.8) Cardiac calcification occurs in the coronary artery, valves, myocardium, and pericardium. In our patient, both mitral valve and myocardium, coronary artery calcification progressed rapidly. Inhibitors,research,lifescience,medical From our estimation, the reason for the rapid progression of calcification is as a result of untreated hyperphosphatemia,

as well as severe secondary hyperparathyroidism of end-stage renal disease. Pathologic calcification of myocardium occurs through two basic mechanisms: Dystrophic and metastatic calcifications. Dystrophic calcification occurs in abnormal tissue, such Inhibitors,research,lifescience,medical as previous myocardial infarction, endomyocardial fibrosis, myocarditis, myocardial abscess, tuberculosis, irradiation and rare cardiac tumors.3) Metastatic calcification occurs in normal tissue in the deranged calcium phosphate metabolism, such as chronic renal failure and hyperparathyroidism.9) In this case, myocardial calcification is associated with inadequate metabolism of calcium and phosphate with subsequent calcium Inhibitors,research,lifescience,medical deposition in normal tissues. Metastatic calcification is an important complication of ESRD patients receiving maintenance dialysis.

Complications of cardiac calcification include complex atrial and ventricular arrhythmias, coronary events and sudden cardiac death, with arrhythmia being the most common cause.10) Vascular calcification is common in chronic renal disease as coronary calcifications can arise from hyperphosphatemia, Inhibitors,research,lifescience,medical hypercalcemia, hyperparathyroidism, and hyperuremia.11) Valvular pathologies in ESRD are sclerosis and calcifications of mitral and aortic valves. Mitral annular calcification is seen in 36% and aortic valve calcification is found in 28% of ESRD patients.12) In some cases, rapid Rutecarpine progression of valve stenosis secondary to hyperparathyroidism of end-stage renal disease was reported.13) Our case showed severe mitral calcification and mild aortic valve calcification. There is no definite therapy for this entity, but parathyroidectomy is a useful means of control, especially in those patients with very high blood levels of PTH.14) In conclusion, our case indicates that dialysis duration and calcium-phosphate metabolisms play roles in cardiac calcification of hemodialysis patients and suggests that secondary hyperparathyroidism can cause rapid progression of cardiac calcification.