A 53-year-old obese man developed abdominal pain after recently commencing haemodialysis. He had undergone a pre-emptive renal transplant 34 years prior for end-stage kidney disease due to renal hypoplasia. Examination found a hard and tender abdominal apron. Biochemistry showed a corrected calcium of 2.83 mmol/L (2.15–2.60), phosphate of 1.56 mmol/L (0.81–1.45) and parathyroid hormone of 29.5 pmol/L (1–7). His calcium and phosphate had been within the normal reference range until commencing haemodialysis.

CT (figure 1) revealed extensive dystrophic subcutaneous calcification, …