Calcification: What is this, how to treat?

What is calcification? This formation of accumulations of insoluble calcium salts where their availability is not provided either from the anatomical point of view, or from the physiological, that is, outside the bones.

Among all the biogenic macroelements of the human body, the proportion of calcium - in the form of crystals of hydroxyapatite bone tissue - is the most significant, although blood, cell membranes and extracellular fluid also contain calcium.

And if the level of this chemical element is significantly increased, then calcification develops - a violation of mineral metabolism (code E83 according to ICD-10).

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of the calcification

Calcium metabolism is a multistage biochemical process, and to date the key causes of calcification, as one of the varieties of the  disturbance of mineral metabolism, are defined and systematized. But, taking into account the close interrelation of all metabolic processes taking place in the body, clinical endocrinology also considers the pathogenesis of calcification (or calcification) deposits.

The primary cause of calculous dystrophy is the supersaturation of blood calcium -  hypercalcemia, the etiology of which is associated with increased osteolysis (destruction of bone tissue) and the release of calcium from the bone matrix.

Because of hypercalcemia, as well as hyperthyroidism or pathologies of parathyroid glands, the development of calcitonin by the thyroid gland reduces, which regulates the calcium content, inhibiting its excretion from the bones. It is assumed that it is the presence of hidden thyroid problems in postmenopausal women - in conjunction with a decrease in the level of estrogens that keep calcium in the bones - that extra-caustic calcium deposits appear, that is, calcification develops in osteoporosis.

There are other pathological conditions that cause calcium salts to concentrate in the wrong places. Thus, in patients with  primary hyperparathyroidism, parathyroid glandular hyperplasia or their hormonally active tumor, the synthesis of parathyroid hormone (parathyroid hormone or PTH) increases, as a result of which the action of calcitonin is suppressed, and the level of calcium in the blood plasma, like bone demineralization, increases.

It is necessary to take into account the importance of phosphorus in calcium metabolism, because the violation of the proportions of the content of these macroelements in the body leads to  hyperphosphatemia, which increases the formation of "calcium deposits" in both bone and soft tissues and blood vessels. A supersaturation of renal parenchyma with calcium salts leads to renal failure and development of nephrocalcinosis.

The mechanism of increased osteolysis with the release of phosphate and calcium carbonate from bone depots in the presence of cancer tumors of any localization is explained by the so-called paraneoplastic syndrome: the growth of malignant neoplasia is accompanied by hypercalcemia, since the mutated cells are capable of producing a polypeptide similar to parathormone.

It is well known that the pathogenesis of the formation of calcium salts can be caused by an excess of vitamin D, which in endocrinology is associated with an increase in the synthesis of 1,25-dihydroxy-vitamin D3-calcitriol, an actively involved process of calcium and phosphorus metabolism. Are involved in the development of calcareous dystrophy of vitamin A hypervitaminosis, leading to osteoporosis, as well as a deficiency of vitamin K1 and endogenous vitamin K2 with food.

In the absence of endocrine pathologies, the content of total calcium in the blood plasma does not exceed the limits of the physiological norm, and then the causes of calcification are different, due to local factors. Among them, precipitation of calcium phosphate on the membranes of organelles of damaged, atrophied, ischemic or dead cells, as well as an increase in the pH of the liquid in the intercellular space due to activation of alkaline hydrolytic enzymes.

For example, the process of calcification in the case of arteriosclerosis of the vessels is as follows. When cholesterol, deposited on the wall of the vessel, is covered with a membrane formed from glycoprotein compounds of the endothelium, a cholesteric plaque is formed. And this is classic atherosclerosis. When the tissues of the membrane of the atheromatous plaque start to "become impregnated" with calcium salts and harden, it is already atherocalcinosis.

Far from the last place in the etiology of calcium metabolism disorders is the shift of the pH-value of the pH to the alkaline side, with a partial dysfunction of the physico-chemical buffer system of the blood (bicarbonate and phosphate), which maintains the acid-base balance. One of the reasons for its violation leading to alkalosis is Burnett's syndrome, which develops in those who consume a lot of calcium-containing foods, taking from an acid reflux or gastritis baking soda or antacids neutralizing the acid of the gastric juice, adsorbed in the digestive tract.

It is believed that any of the above-mentioned endocrine disorders aggravates the excessive intake of calcium from food. However, according to Harvard University researchers, there is still no strong evidence that calcium food increases the likelihood of calcification of tissues, as it does not cause a steady increase in the level of Ca in the blood.

[9], [10], [11], [12], [13], [14], [15], [16]

Risk factors

As clinical practice shows, in some cases, the trigger of the calcification process is various infections - tuberculosis, amoebiasis, toxoplasmosis, trichinosis, cysticercosis, meningitis, encephalitis, etc. - and the accompanying inflammatory processes with tissue damage.

There are also the following risk factors for calcification:

• fractures of bones, with the fusion of which the activation of osteoclasts, utilizing damaged bone tissue with its enzymes, takes place;
• deterioration of trophism of bone tissues with prolonged bed rest or paralysis (paraplegia), leading to immobility;
• malignant neoplasms;
• chronic granulomatous diseases (sarcoidosis, Crohn's disease);
• autoimmune pathologies of a systemic nature (scleroderma, rheumatoid arthritis, lupus);
• chronic kidney pathologies with a decrease in their filtration capabilities (with the disruption of the exchange of phosphorus and calcium with the development of secondary hyperparathyroidism);
• chronic form of insufficiency of the adrenal cortex -  Addison's disease, leading to hypocorticism and cortisol deficiency, which increases the content of Ca in the blood;
• hypercholesterolemia, elevated LDL level in the blood, systemic atherosclerosis;
• heart defects, endocarditis of infectious origin, cardiac operations;
• vascular anomalies, surgical interventions on vessels;
• osteoporosis and osteopenia (decrease in bone mineral density);
• diabetes mellitus (with a high level of glucose in the blood deteriorates the absorption of magnesium, which prevents deposition of calcinates);
• an insufficient level of magnesium in the body (without the presence of which insoluble calcium salts can not be transformed into soluble);
• malabsorption syndrome (in which the binding of Ca inside the cells increases);
• age-related degenerative-dystrophic changes in bone and connective tissue, involutional changes in the walls of blood vessels;
• long-term use of diuretics related to the group of thiazites (reducing renal excretion of calcium), corticosteroids, heparin, anticonvulsants and laxatives;
• Hemodialysis (increasing the risk of calcification of the arteries);
• radiotherapy and chemotherapy of oncological diseases.

A separate item in this list should be noted calcification and heredity, in particular, a genetically determined predisposition to deforming osteodystrophy; collagen and hereditary chronic granulomatous disease; family hypocalciuric hypercalcemia (due to mutation of genes encoding calcium receptor-sensitive cell membrane receptors).

Conglomerates of calcium in the intervertebral discs of the lumbar region, in the hip, knee and shoulder joints and surrounding soft tissues can be associated with a slowly progressing genetic disease, like ochronosis (alkaponuria).

[17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28]

Symptoms of the calcification

The symptoms of calcification are caused not so much by its etiology as by the specific location of calcifications. In this case, they themselves appear rarely or not at all, since in most cases they accompany other nosological forms.

The initial calcification can be detected only with the help of hardware visualization - accidentally or when a patient with a blood calcium level is assigned an examination.

But the first signs of formation near the joints of the extremities subcutaneous calcium granulomas, which are soldered to the skin and begin to appear through it as they grow - can be seen without X-rays. This scleroderma calcification of the skin or dystrophic calcification with scleroderma.

Soft tissue calcification

In addition to scleroderma calcification of the skin, calcification of soft palpable tissue can be detected in posttraumatic  ossifying myositis : a dense area is felt in the muscle, in which the calcification is deposited. The main symptoms are manifested in the form of intense pain and stiffness of movements, the skin over the lesion blushes, and the subcutaneous tissue swells.

Focal calcification of the gluteus muscles (small or medium) - with moderate soreness of varying strength and swelling - may develop after trauma, burns or intramuscular administration of medications. Severe pain in the buttocks and even stitching on walking causes calcification foci, formed due to arthrosis of the hip joint, sarcoma or progressive congenital Gaucher disease. With paralysis of the extremities, dystrophic calcification affects the muscles of the lower leg and thigh.

And with toxoplasmosis, ochronic disease, or retinal malignant tumor (retinoblastoma), there is calcification of the oculomotor muscles, which keep the eyeball in orbit. Reducing their elasticity prevents the normal movement of the eyes.

When depositing phosphoric-calcium salts in synovial bags of joints and periarticular tissues, metabolic calcification of tendons, ligaments, hyaline and fibrous cartilage is noted. Can be diagnosed: calcifying tendinitis tendon of the supraspinum muscle of the shoulder; Chondrocalcinosis in the ankle, knee and hip joints; calcification of the tendon of the quadriceps muscle of the thigh (in the zone of the tubercle of the tibia or near the patella). In all cases, local pain, signs of local inflammation, and limitation of mobility are noted.

[29], [30], [31], [32], [33], [34], [35], [36], [37], [38]

Vascular calcification

Calcium deposits on the walls of blood vessels most often appear with atherosclerosis, involutional fibrosis of vascular walls, autoimmune and congenital endothelial dysplasia - as dystrophic calcification.

Vessel constriction by 15-25% and slowing of the blood flow, to which calcification of the aortic arch can lead in the places of formation of atherosclerotic plaques, causes the onset of attacks of weakness and headaches; dizziness and fainting; feelings of discomfort in the mediastinum and paresthesia of the fingers. In addition, diffuse calcification of the aorta with a similar symptomatology is observed with syphilitic mezaortite and autoimmune aortoarteriitis.

The pronounced calcification of the thoracic aorta, in addition to the already mentioned symptoms, leads to shortness of breath, arrhythmia and increased blood pressure, pain in the region of the heart, giving to the shoulder, neck, scapula and the area of the hypochondrium. A calcification of the abdominal aorta makes itself felt by a decrease in appetite and total body weight; aching pains in the abdominal cavity associated with eating; problems with the intestines; weight and pain in the legs.

Calcification of the arteries, as a rule, accompanies the same atherosclerosis or age-related decrease in the elasticity of the vascular walls - fibrosis and calcinosis, which affects arterial vessels in the zones of their bifurcation. Thus, calcification of carotid arteries providing blood to the brain, in many patients is detected in the region of the carotid sinus, where the common artery is divided into the outer and inner. The narrowing of the lumen of these vessels, as well as the mouth of the subclavian artery - if there is diffuse calcification of the arteries of the neck - is manifested not only in the form of headache, dizziness, temporary loss of vision, nausea and vomiting, but also neurological symptoms: paresthesia of limbs, movement and speech disorders. The result may be a stroke, for more details see -  Stenosis of the carotid artery.

Constantly cold feet, limping, worsening trophism of the skin on the toes (with foci of atrophy and ulceration), pain in the legs, as well as an erection disorder in men, stenosis and obliteration can lead to calcification of the iliac arteries (originating from the split abdominal aorta).

If calcification of the arteries of the lower extremities develops (in half of cases it is atherocalcinosis in the elderly, in others it is a consequence of diabetes mellitus in persons 35 years and older), its typical localization is the superficial femoral artery or the artery of the shin. And among the symptoms, weight and pain in the legs, paresthesia and seizures are noted.

Heart calcification

Identifying the calcification of the heart, cardiologists distinguish the calcification of its membranes, supplying them with blood of the coronary arteries and regulating the blood flow of the valves.

In patients with calcifications in the outer shell of the heart (pericardium) or its muscular membrane (myocardium), all signs of heart failure are noted: shortness of breath, pressure and burning behind the sternum, palpitations and pains in the heart, swelling of the legs, sweating at night.

Coronary calcification (calcification of the coronary arteries) has symptoms of angina, that is, expressed dyspnea and radiating to the shoulder chest pains.

Non-rheumatic lesions of cardiac valves with fibrosis, calcification and stenosis include calcification of the aortic valve or calcification of the aortic root in the area of the fibrous ring, which can be defined as degenerative calcification of the aortic valve or degenerative calcified stenosis of its valves. No matter how he is called, he leads to cardiac, coronary or left ventricular failure with the corresponding cardiological symptoms.

The degree of calcification, as well as the degree of stenosis, is established during CT scanning: calcification of aortic valve 1 degree means the presence of one deposit; calcification of the aortic valve of the 2nd degree is determined if the calcifications are several; with diffuse lesions that can seize nearby tissues, a calcification of the aortic valve of the 3rd degree is diagnosed.

Calcification of the mitral valve or mitral calcification accompanies similar symptoms plus hoarseness and coughing attacks.

Brain calcification

In the form of focal or diffuse deposits, calcification of the brain is detected with MRI in patients with tumors - teratoma, meningioma, craniopharyngioma, intraventricular epindimoma, adenoma of the pineal gland. Multiple calcifications are formed in gliomas, glioblastomas and giant cell astrocytomas. Among the most common symptoms are severe headaches, visual disturbances, paresthesia and paresis of limbs, tonic-clonic seizures.

Damage to individual structures due to encephalopathies of infectious and parasitic origin (toxoplasmosis, cysticercosis, cryptococcosis, CMV) can cause focal calcifications in the subarachnoid space, in gray and white matter. They manifest themselves in different ways - in accordance with the loss of functions of the neurons of the affected areas.

Often asymptomatic calcification of the basal nuclei (basal ganglia of the brain), as well as the dentate nucleus of the cerebellum, is noted in old age. And with the hereditary disease of the Farah, which can manifest itself in adults of different ages, neurodegenerative changes (cognitive and psychic) are steadily progressing.

[39], [40], [41], [42], [43], [44], [45]

Calcification of bones and joints

Dystrophic calcification of bones accompanies almost all bone growths. For example, in benign osteochondria on tubular and flat bones cartilaginous growths are formed, in which calcium salts are deposited. Such calcified growths can be painful and impair mobility.

Calcification of the lower extremities - with bone sarcoma, affecting the tissue of the tubular bones (hip, small or tibial) - pain and deformity increase, leading to disruption of motor functions.

Given the tendency of glycosaminoglycans of connective periarticular tissues and cartilages to attract Ca2 +, calcification of the joints can be considered a comorbid process in the development of joint diseases, especially when their chronic forms are characteristic of people of mature and advanced age.

Calcification of the shoulder joint, ulnar and radiocarpal, calcification in the hip joint zone, calcification of the knee joint with the deposition of calcium hydrate of calcium pyrophosphate in the synovial membrane or articular bag, cause inflammation, swelling, severe pain and leads to limitation of limb mobility.

[46], [47], [48], [49], [50], [51], [52]

Calcification of visceral organs and glands

First of all, lung calcification is associated with tuberculosis (in which tuberculosis granulomas and areas of adjacent necrotic tissues are calcified). Calcifications can be exposed to the lungs and bronchi in patients with chronic pneumoconiosis (silicosis, asbestosis, etc.) or parasitic pneumocystoses (ascariasis, toxoplasmosis, echinococcosis, etc.); in the presence of cysts or due to damage after prolonged forced ventilation of the lungs.

Calcifications appear in the lungs in patients with sarcoidosis or metastatic leukemia. About calcification of the pleura read the article -  Pleural fibrosis and calcification

[53], [54], [55], [56], [57], [58], [59]

KALZINOSIS OF KIDNEYS

Symptoms of renal insufficiency - polyuria, nausea, thirst, convulsions, general weakness, low back pain - manifested itself nephrocalcinosis or dystrophic renal calcification, chronic form of glomerulonephritis (with calcints in the tissue of membranes of the nephron tubules and in the glomerular epithelium), kidney tumors (carcinoma, nephroma ).

The calcification of pyramids of kidneys detected by ultrasound means the formation of a cluster of calcium salts in the triangular regions of the medulla of the kidney, that is, where the neurons are filtering and forming urine. A parietal calcification in the kidney develops when atrophy or die parenchyma cells - due to pyelonephritis or polycystosis.

Adrenal calcification

When a history of patients has tuberculosis or cytomegalovirus adrenalitis, cystic formation in their brain substance or Addison's disease (destroying this substance), adrenal adrenal cortex, pheochromocytoma, carcinoma or neuroblastoma, adrenal calcification is their "fellow traveler".

He has no symptoms of his own, so that the main signs of adrenal insufficiency are observed: general weakness, dizziness, increased skin pigmentation, poor appetite and weight loss, bowel problems, myalgia, numbness in the skin, increased irritability, etc.

[60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71]

Liver calcification

Whatever the causes of calcification of the liver, as in the case with other internal organs, the symptoms of calculous dystrophy will be within the clinical picture in the defeat of hepatocytes. Therefore, there may be digestive disorders (due to decreased production of bile), and weight loss, and pain in the hypochondrium (right), and a bitter belch.

Calcification of the spleen in most cases is atherocalcinosis of the splenic artery, or by partial calcification of the organ of the hamartoma formed in the parenchyma, which does not manifest itself in any way and is detected accidentally.

Calcification of the gallbladder

According to gastroenterologists, calcification of the gallbladder has two main causes: chronic inflammation (cholecystitis) and oncology (carcinoma). In the case of cholecystitis, often accompanied by cholelithiasis, the degree of calcium dystrophy is so high that the walls of the bladder resemble porcelain in hardness and fragility, and physicians even call such a gall bladder porcelain. In this case, patients complain of abdominal pain (after each meal), nausea and vomiting.

[72], [73], [74], [75], [76], [77]

Pancreatic calcification

Most of the focal calcification of the pancreas develops at the site of damage and death of its acinar cells, which are replaced by fibrous or fat tissue - in the chronic form of pancreatitis. Then pancreatitis is called calcific, but symptoms of chronic pancreatitis appear . If there are cysts or pseudocysts in the pancreas, they can also contain calcinates.

Calcification of the thyroid gland

With an increase in the thyroid gland (goiter), calcification occurs due to the alteration and proliferation of thyrocytes - the cells of its tissue. If the goiter type is colloidal, then with its growth, in connection with the deterioration of tissue trophism, cells die, and necrotic areas become calcified, often with ossification.

Calcification of the thyroid gland for the presence of cysts in it appears only if its size is significant. And then symptoms of goiter in the form of pain in the neck and headaches are noted; sensation of a foreign body in the throat, perspiration and coughing; general weakness and attacks of nausea.

[78], [79], [80]

Calcification of lymph nodes

Lymph nodes are scattered throughout the body, and calcification of lymph nodes can be of different localization - with lymphadenitis, lymphocytic leukemia, lymphogranulomatosis,  tuberculosis of the lymph nodes.

Lime dystrophy can affect enlarged or inflamed lymph nodes in people with rheumatoid arthritis, scleroderma, vasculitis, Sharpe's syndrome and other systemic collagen infections (congenital and acquired).

In lymph nodes located in the chest, calcifications are formed with pulmonary tuberculosis, chronic pneumoconiosis, sarcoidosis.

[81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92]

Calcification in women

Calcification of the mammary glands, according to some data, shows at a mammogram not less than 10% of women of childbearing age with fibrosis of mammary glands, fibroadenomas and fibrocystic mastopathy, and also at half of those over fifty. More information in the material -  Calcinates in the mammary gland.

In a quarter of the examined women, gynecologists identify calcified myomatous nodes - myocyte calcinosis, which gives the same symptoms as the usual myoma: pelvic pressure, frequent urination and constipation, lower abdominal pain and lower back pain, longer and more intense menstruation.

In any pathology of the ovaries - adnexitis, polycystosis and single cysts, malignant cilioepithelial cystoma or carcinoma - there may be calcification of the ovary, the manifestation of which is limited by the  symptoms of adnexitis.

A separate problem is calcification during pregnancy. According to clinical studies, in order to minimize the risk of developing nephropathy in pregnant women, accompanied by an increase in blood pressure (pre-eclampsia), the daily intake of calcium preparations from the middle of the second trimester may be 0.3-2 g. However, calcium is needed not only for this, read -  Calcium during pregnancy. And its intake by pregnant women who are not threatened with preeclampsia should not exceed 1.2 grams per day (at a dose outside of pregnancy 700-800 mg).

Pregnant women are recommended to take calcium in order to have enough to form the skeleton of the child, and so that the mother's body does not suffer. But thanks to a whole complex of hormones, the body of healthy women during pregnancy adapts to provide the fruit with calcium not due to its release from the bone matrix. Compensatory mechanisms are included: during the gestation of the child, the absorption of this macerelent from foodstuffs increases, the inverse absorption of Ca in the intestine increases, its excretion through the kidneys and blood content decreases, the production of hormones of parathyroid hormone and calcitonin, and also calcitriol increases.

If supplemental intake of calcium preparations disrupts the natural regulation of mineral metabolism, calcification is possible in pregnancy, which affects the excretory system working in an enhanced mode - with the development of nephrocalcinosis.

Not only the future mother may suffer: with excess calcium, the fontanel is closed too early in the body of a newborn, and this increases intracranial pressure and interferes with the normal development of the brain. In children of the first year of life due to the acceleration of ossification (ossification) of porous bone tissue, the process of its replacement by lamellar bone is disrupted, and the growth of the child slows down.

One of the complications of pregnancy is calcification of the placenta, although the accumulation of insoluble calcium salts in the tissues of the maternal side of the mature (mature) placenta is detected in almost half of the cases of a successful pregnancy that is resolved, that is, it can not be considered pathology. In other cases calcifications are formed either because of early maturation of the placenta, or because of endocrine pathology or the presence of risk factors for the development of calcification in the mother.

Calcinates in the immature placenta (before the gestation period of 27-28 weeks) can worsen its blood supply and provoke fetal hypoxia, delay its prenatal development, congenital pathologies and abnormalities, cause premature birth - all depends on the maturity of the placenta and the level of calcareous dystrophy.

In obstetrics, based on the results of ultrasound at the period from the 27th to the 36th week, determine the 1 degree of calcification of the placenta (calcification of the placenta 1 degree) - in the form of individual microcalcinates. Calcium placenta 2 degrees - from 34th to 39th week - means the presence of calcifications, visualized without further increase. And with calcification of the placenta 3 degrees (which is determined from the 36th week), numerous foci of calcareous dystrophy are revealed.

In this case, a special concern is calcification of the placenta 2 degrees at the term of 27-36 weeks or the presence of microcalcinates up to the 27th week of pregnancy.

[93], [94], [95], [96], [97], [98], [99], [100], [101], [102]

Calcification in men

Calcium prostate can occur due to hyperplasia, adenoma or adenocarcinoma of the prostate gland, as well as due to its diffuse changes associated with age-related involution. For more details see the material -  Diffuse changes in the prostate gland.

Calcitosis of the scrotum - with pain in the groin area - is possible in the chronic form of orchitis, scleroderma, sebaceous gland cysts, after injuries, as well as in elderly men with age-related degeneration of the genital tissues.

Focal or diffuse calcification of the testicles is associated with inflammatory processes of an infectious nature, in particular tuberculosis, epididymitis or phoepididymitis, the presence of teratoma or oncology and may manifest as discomfort in the groin (due to tightening of the testicle structure) and pain attacks.

[103], [104], [105], [106], [107], [108], [109], [110], [111]

Calcification in children

Most of the above causes and risk factors for dystrophic calcification cause calcification in children, so specialists pay attention to those diseases that lead to the manifestation of calcification in childhood, sometimes in infants. Such pathologies include:

• Wolman's disease - with diffuse calcifications of both adolescents in newborns;
• congenital toxoplasmosis - causes focal calcification in the cortex, subcortex or brain stem. The surviving children atrophy the optic nerves, develop hydrocephalus and a number of endocrinopathies; they lag behind in development - physical, mental and mental;
• Conrady-Huenermann syndrome or congenital calcific chondrodystrophy, in which calcifications are formed in the articular cartilage of the epiphyses of the tubular bones of the upper and lower extremities;
• congenital idiopathic calcification of arteries;
• Albright's syndrome (localization of Ca deposition - subcutaneous soft tissues, eye mucosa and cornea, muscle tissues, artery walls, myocardium, renal parenchyma);
• the elastic pseudo-dandy Darya (with the formation of self-resolving nodular or plaque-like calcifications of the skin);
• hereditary oxalose, which causes diffuse calcification of the kidneys (calcification consists of calcium oxalate) with severe renal failure and calcification of the joints. The disease progresses and leads to a lag in growth.

[112], [113], [114], [115], [116], [117]

Forms

According to the nature of the pathological accumulation of calcium in the tissues, there are segmental - focal calcification and disseminated or diffuse calcification. Also, this process can be intracellular, extracellular and mixed.

And, depending on the pathogenetic features, such types of calcification as metastatic, dystrophic and metabolic (or interstitial) are isolated, the pathogenesis of which has not been fully clarified. Therefore, foreign endocrinologists do not consider metabolic calcification as a separate species, considering it synonymous with metastatic, and is associated with impaired function of the buffer system of blood in combination with elevated levels of phosphate in the blood.

Metastatic calcification (in the sense of the formation of pathological foci of depositing calcium salts) is determined only with an elevated level of calcium in the blood plasma. In most cases, this is a mild calcification that affects tissues with an alkaline reaction of the extracellular fluid and a content of polyanionic components that actively "catch" and firmly "retain" calcium cations. Among such tissues: acidic glycosaminoglycans elastin, collagen vascular endothelium and reticulin skin; chondroitin sulfate of ligaments, cartilage, periarticular capsules, as well as heparan sulfate proteoglycans of the extracellular matrix of liver, lung, heart, and other tissues.

Dystrophic calcification has a local (focal) nature and does not depend on hypercalcemia in any way. Calcinates "capture" damaged cells and free areas of the inflamed or atrophied tissue, foci of autolysis or necrosis, granulomas and cystic formations. Dystrophic calcification is subjected to: heart valves and myocardium (in the zone of post-infarction cicatrix or in the presence of myocarditis); lungs and pleura (affected by mycobacteria tuberculosis or other pathogenic microorganisms); Vascular wall (especially in the presence of atherosclerotic plaques and thrombi); epithelial lining of renal tubules; fibrotic nodes in the uterus or mammary glands, as well as in various structures of other organs with comorbid diseases.

For example, the dystrophic form includes calcification in scleroderma - an autoimmune disease of connective tissue with increased collagen synthesis and pathological changes in the skin, subcutaneous tissue and thickening of the capillary walls.

[118], [119], [120], [121], [122]

Complications and consequences

Any violation of mineral metabolism can have serious consequences and complications, negatively affecting the condition and functioning of individual systems and organs. What is the risk of calcification?

Vascular calcification or atherocalcinosis disrupts the circulatory system and leads to persistent ischemia, and when calcium deposits are localized on the walls of the vessels of the legs, tissue ischemia develops into necrosis. Complications of calcaneous dystrophy of the walls of the thoracic aorta (and aortic valve) can be not only chronic heart failure, but also a heart attack. Aneurysm of the abdominal aorta with its rupture and death can be a consequence of calcification of the walls and persistent stenosis of the vessel.

Calcifications disturb the function of the mitral valve because of its prolapse, which is complicated by stagnation of blood in a small circle of circulation, the development of cardiac asthma and heart failure.

If the centers of calcification of soft tissues are localized near the bones, they can fuse with the bone, which leads to deformity of the limb. When calcification has affected joints, a decrease in the ability to move can seat a person in a wheelchair.

[123], [124], [125], [126], [127], [128], [129], [130], [131], [132]

Diagnostics of the calcification

Calcite deposits in the tissues of the internal organs, in the structures of the brain, on the walls of the vessels, in the joints, in the lymph nodes and glands can only be visualized, that is, instrumental diagnostics comes first: X-rays and scintigraphy; ultrasound examination, computer and magnetic resonance imaging of the relevant organs; electroencephalography, electro and echocardiography; osteoscintigraphy and osteodensitometry of bones; Angiography, duplex angioscanning and ultrasonic dopplerography of vessels; endoscopic examination of the cavity organs, etc.

Diagnosis of calcification involves the conduct of laboratory studies:

• general blood analysis;
• analysis on the level of  total and ionized calcium in the blood ;
• blood tests for the content of magnesium and phosphorus, cholesterol and sugar, urea and bilirubin; on residual and C-reactive protein, alkaline phosphase, creatinine, amylase, aminotransferase;
• blood tests for the level of calcitonin, calcitriol, parathyroid hormone, cortisol;
• urine analysis for calcium, phosphorus and oxalates.

[133], [134], [135], [136], [137], [138], [139], [140], [141]

Differential diagnosis

The list of diseases that should be excluded in the detection of calcification is so extensive that its differential diagnosis is often performed with the involvement of physicians of different profiles and the appointment of an additional examination.

Treatment of the calcification

Regarding the methods currently treated with calcinosis, it should be noted that the treatment of metabolic disorders takes into account their etiology and is aimed at the underlying disease, for example, a malignant tumor, kidney failure or hypercholesterolemia.

In particular, with atherosclerosis - for the reduction of LDL in the blood - statins are prescribed: Lovastatin (Mevakor), Simvastatin (Simgal), Rosuvastatin (Rosart, Rosukard, Tevastor), etc.

To reduce the reabsorption of calcium by the kidneys, it is forcibly removed from the body by shock courses of loop diuretics, most often Furosemide (other trade names - Furozan, Lasix, Uritol) - in tablets or parenterally; the doctor determines the dosage individually, taking into account the state of the cardiovascular system (as at the same time the drug displays sodium, potassium and magnesium). In this case, you should increase the amount of liquid consumed to at least two liters per day.

Intestinal calcium binding inhibits glucocorticosteroids: given in / in injections of Methylprednisolone (once a day for 125 mg for 10 days); In / m administration of Kenalog (Triamcinolone) - one injection daily (40-80 mg), treatment course - 14 days. Especially well suited for treatment with steroids is hypercalcemia associated with oncology.

The level of calcium in the blood reduces and preparations of the group of calcimimetics: Tsinakaltset (Mimpara, Sensipar) and Etelcalcetid (Pasarbiv), as well as biophosphonates -  Pamidronate  (Pamidria, Pamiredin, Pamired) and Sodium Ibandronate (Boniva).

There are preparations for cleaning vessels from calcification: EDTA-sodium (Ethylenediaminetetraacetate sodium, Disodium endrate, Trilon B) and Sodium thiosulfate (Sodium hyposulfite). EDTA-sodium is administered at a dose of 200-400 mg (intravenously) once a day for three to five days. Sodium thiosulfate in the form of a solution is taken orally (2-3 g) once a day. Side effects include nausea, vomiting, diarrhea, muscle spasms.

To date, the treatment of calcinosis with magnesium is an indispensable component of the complex therapy of this pathology. Preparations containing Mg - Magnesium hydroxide, Magnesium lactate, Magnesium citrate (Magnesol), Magnumum, Magne B6 (Magvit B6), etc. - reduce the activity of parathyroid hormone and block the deposition of insoluble calcium salts.

It is also recommended to take vitamins B6, E, K1, PP (nicotinic acid).

Physiotherapeutic treatment

The task of physiotherapy procedures, appointed in cases of calcification of bones, joints and muscles: improve circulation and trophism of tissues, as well as relieve pain. To this end, electrophoresis with drugs is performed; UHF, microwave and magnetic therapy; applications of ozocerite, paraffin, sulphide mud; balneotherapy (bath treatment), etc.

Alternative treatment

No prescription that offers folk medication can help when depositing calcinates in the lungs, the basal ganglia of the brain, the kidneys, or the pancreas.

Almost all alternative agents, including herbal treatment, are used for one purpose - to lower the cholesterol content so that it does not settle on the walls of blood vessels and does not lead to atherosclerosis. Read the article -  Treatment of high cholesterol, there is a section on alternative means. Add to the means indicated there a decoction or water infusion of a golden mustache and powder from the dried roots of a dandelion.

By the way, garlic for calcification is also used "from cholesterol". In addition to the known alcoholic tincture of garlic, the dose of which increases by one drop in each dose, make a mixture of grated garlic with peanut butter (1: 3) and lemon juice. This drug also reduces blood glucose in diabetes and promotes resorption of blood clots, which can also be calcified.

It is said that the help of sea kelp from calcinosis (laminaria) is due to the high content of magnesium (170 mg per 100 g). However, calcium in them is quite a lot: in the same 100 g - 200 mg. And on the pharmaceutical packaging dry kelp indicated that it can be used for constipation.

[142], [143], [144], [145], [146], [147], [148], [149], [150], [151], [152]

Surgery

Calcinates of large size in the knee, shoulder or elbow joint can be removed operatively. Surgical treatment is performed with calcification of vessels: stents are established, bougies or dilate the lumen of the vessel by balloon angioplasty. Instead of a solidified from the valve or articular cartilage, a prosthesis is installed.

Calcinants of soft tissues are removed endoscopically, but partial or complete resection of the body (ovary, prostate, gallbladder) is sometimes excluded - with the complete loss of its functions or the threat of irreversible consequences.

Nutrition for calcification

A special diet for calcification, including a diet for calcification of vessels, aorta or gallbladder, has not been developed.

Therefore, you just need to know what foods can not be eaten with calcification of the aorta.

Among the recommendations for the exclusion or maximum restriction of certain products, note two points - the presence of calcium and vitamin D:

Products with a high content of calcium: milk and all dairy (especially cheese and cheese), beans and soybeans, sesame, almonds, hazelnuts, sunflower seeds, cabbage, lettuce, carrots, radishes, celery, spring onions, basil, pumpkin, melon, green olives, cherry, raspberry, dried apricots, raisins, figs, dates.

Due to the high content of vitamin D, it is necessary to exclude from the diet egg yolk, beef and cod liver, fat marine fish. Bread is better not to use yeast.

But products rich in magnesium should be present in the menu, and these are ceps (dried), walnuts, pistachios, peanuts, pumpkin seeds, wheat bran.

Add here grapes containing vitamin K, avocados and kiwis, as well as all the usual cereal grains, which contain phytin (inhibiting absorption of calcium).

Prevention

Prevention of metabolic disorders, as usual, does not have clear formulated and scientifically based recommendations. But the correct diet for calcification, despite the leveling of its role by some specialists, is so far the only specific factor.

[153], [154], [155], [156], [157], [158], [159], [160]

Forecast

In most cases, the forecast for calcification is not very comforting: to cure, that is, to establish the correct exchange of calcium in the body - in the presence of major diseases - few people succeed.

A calcification of the aortic valve and heart, coronary calcification have an unfavorable prognosis and can lead to a sudden lethal outcome.

[161], [162], [163], [164], [165], [166], [167]