{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:55:12Z","timestamp":1792068912940,"version":"4.4.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Extensive parenchymal brain calcification is uncommon in chronic kidney disease (CKD): intracranial vascular calcification affects up to 10% of uremic patients, but widespread Fahr\u2010type parenchymal deposits are rare and, where reported, have occurred in patients with a coexisting hypoparathyroid or parathyroid\u2010hormone (PTH)\u2010resistant state. We describe a man in his 50s with autosomal dominant polycystic kidney disease (ADPKD) and Stage 5 CKD who presented with word\u2010finding difficulty, gait imbalance, and myoclonus and was found to have extensive symmetric calcification of the basal ganglia, thalami, dentate nuclei, and subcortical white matter. He carried an unverified childhood diagnosis of pseudohypoparathyroidism made at age 13. At presentation, total calcium was 6.1\u20136.3\u2009mg\/dL, phosphate 5.8\u2009mg\/dL, intact PTH 194\u2009pg\/mL, creatinine 6.21\u2009mg\/dL, and alkaline phosphatase normal. Over the following 10\u2009months, intact PTH fell rather than rose, reaching 56\u2009pg\/mL during treatment with calcium, calcitriol, sevelamer, and hemodialysis, all of which lower PTH whatever the underlying cause. The calcium\u2013phosphate product was low at presentation (36.5\u2009mg\n                    <jats:sup>2<\/jats:sup>\n                    \/dL\n                    <jats:sup>2<\/jats:sup>\n                    ) but rose to 58\u201362\u2009mg\n                    <jats:sup>2<\/jats:sup>\n                    \/dL\n                    <jats:sup>2<\/jats:sup>\n                    later, and single values cannot exclude earlier CKD\u2010related mineral abnormality. No pathogenic variant was identified on an 866\u2010gene panel. Neither the product nor the PTH trajectory separated renal from non\u2010renal contributions. We present this as a diagnostic\u2010reasoning case that raises, but cannot resolve, the question of causation and suggest that such calcification should not be attributed to CKD\u2010mineral and bone disorder by default.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.73595","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:40:15Z","timestamp":1792068015000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extensive Parenchymal Brain Calcification in a Patient With Autosomal Dominant Polycystic Kidney Disease and Stage 5 Chronic Kidney Disease"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5891-9827","authenticated-orcid":false,"given":"Noorelle","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine MedStar Washington Hospital Center, Georgetown University  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3321-7064","authenticated-orcid":false,"given":"Nicholas","family":"Streicher","sequence":"additional","affiliation":[{"name":"Department of Neurology Georgetown University School of Medicine  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/1750-1172-8-156","article-title":"Fahr's Syndrome: Literature Review of Current Evidence","volume":"8","author":"Saleem S.","year":"2013","journal-title":"Orphanet Journal of Rare Diseases"},{"key":"e_1_2_15_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.clineuro.2021.106514","article-title":"Fahr's Syndrome due to Hypoparathyroidism Revisited","volume":"202","author":"Kalampokini S.","year":"2021","journal-title":"Clinical Neurology and Neurosurgery"},{"issue":"1","key":"e_1_2_15_4_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/BF00342514","article-title":"Prevalences of CT\u2010Detected Calcification in the Basal Ganglia in Idiopathic Hypoparathyroidism and Pseudohypoparathyroidism","volume":"27","author":"Illum F.","year":"1985","journal-title":"Neuroradiology"},{"issue":"2","key":"e_1_2_15_5_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1111\/j.1365-2265.2012.04353.x","article-title":"Prevalence and Progression of Basal Ganglia Calcification and Its Pathogenic Mechanism in Patients With Idiopathic Hypoparathyroidism","volume":"77","author":"Goswami R.","year":"2012","journal-title":"Clinical Endocrinology"},{"issue":"4","key":"e_1_2_15_6_1","article-title":"Cerebral Calcifications as a Result of Primary Hyperparathyroidism: A Report of a Rare Case","volume":"16","author":"Hyusein R. R.","year":"2024","journal-title":"Cureus"},{"issue":"2","key":"e_1_2_15_7_1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s40618-020-01355-w","article-title":"Basal Ganglia Calcification in Hypoparathyroidism and Pseudohypoparathyroidism: Local and Systemic Metabolic Mechanisms","volume":"44","author":"Zavatta G.","year":"2021","journal-title":"Journal of Endocrinological Investigation"},{"issue":"1","key":"e_1_2_15_8_1","first-page":"36","article-title":"Brain Calcinosis in a Dialysis Patient With Hypoparathyroidism","volume":"1","author":"Gionanlis L.","year":"2008","journal-title":"NDT Plus"},{"issue":"3","key":"e_1_2_15_9_1","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1038\/ng.1077","article-title":"Mutations in SLC20A2 Link Familial Idiopathic Basal Ganglia Calcification With Phosphate Homeostasis","volume":"44","author":"Wang C.","year":"2012","journal-title":"Nature Genetics"},{"issue":"10174","key":"e_1_2_15_10_1","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/S0140-6736(18)32782-X","article-title":"Autosomal Dominant Polycystic Kidney Disease","volume":"393","author":"Gall C.\u2010L.","year":"2019","journal-title":"Lancet"},{"issue":"4","key":"e_1_2_15_11_1","first-page":"S1","article-title":"K\/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease","volume":"42","author":"National Kidney Foundation","year":"2003","journal-title":"American Journal of Kidney Diseases"},{"issue":"1","key":"e_1_2_15_12_1","first-page":"1","article-title":"KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease\u2013Mineral and Bone Disorder (CKD\u2010MBD)","volume":"7","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD\u2010MBD Update Work Group","year":"2017","journal-title":"Kidney International Supplement"},{"issue":"8","key":"e_1_2_15_13_1","doi-asserted-by":"crossref","first-page":"e3005","DOI":"10.1210\/clinem\/dgab208","article-title":"Pseudohypoparathyroidism: Focus on Cerebral and Renal Calcifications","volume":"106","author":"Mazoni L.","year":"2021","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"issue":"9","key":"e_1_2_15_14_1","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1038\/ki.2008.644","article-title":"The Emerging Role of Phosphate in Vascular Calcification","volume":"75","author":"Giachelli C. M.","year":"2009","journal-title":"Kidney International"},{"issue":"2","key":"e_1_2_15_15_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/MOP.0000000000000195","article-title":"Autosomal Dominant Polycystic Kidney Disease in Children","volume":"27","author":"Cadnapaphornchai M. A.","year":"2015","journal-title":"Current Opinion in Pediatrics"},{"issue":"7","key":"e_1_2_15_16_1","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1681\/ASN.2019070728","article-title":"Uremic Toxic Blood\u2010Brain Barrier Disruption Mediated by AhR Activation Leads to Cognitive Impairment During Experimental Renal Dysfunction","volume":"31","author":"Bobot M.","year":"2020","journal-title":"Journal of the American Society of Nephrology"},{"issue":"10","key":"e_1_2_15_17_1","doi-asserted-by":"crossref","first-page":"2988","DOI":"10.1016\/j.ekir.2024.07.021","article-title":"Increased Blood\u2010Brain Barrier Permeability and Cognitive Impairment in Patients With ESKD","volume":"9","author":"Bobot M.","year":"2024","journal-title":"Kidney International Reports"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73595","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73595","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73595","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:40:17Z","timestamp":1792068017000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/ccr3.73595"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73595","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-08-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73595"}}