1
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Yousuf S, Busch D, Renner R, Schliep S, Erfurt-Berge C. Clinical characteristics and treatment modalities in uremic and non uremic calciphylaxis - a dermatological single-center experience. Ren Fail 2024; 46:2297566. [PMID: 38178572 PMCID: PMC10773653 DOI: 10.1080/0886022x.2023.2297566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
Calciphylaxis (CP) is a serious, potentially life-threatening disease that presents with medial calcification of small-sized vessels and painful ischemic ulcerations. Although calciphylaxis is frequently seen in patients with end-stage kidney disease on dialysis (calcific uremic arteriolopathy, CUA), there are reported cases of nonuremic calciphylaxis (NUC), which often remain undiagnosed. We conducted a retrospective chart review at our dermatological hospital and evaluated data concerning the epidemiology, comorbidities, medication, laboratory abnormalities, and therapeutic approaches of 60 patients diagnosed with calciphylaxis between 01/2012 and 12/2022. We identified 21 patients diagnosed with NUC and 39 with kidney disease. The predilection sites of skin lesions were the lower legs in 88% (n = 53), followed by the thigh and gluteal regions in 7% (n = 4). Significant differences were identified in comorbidities, such as atrial fibrillation (p < 0.001) and hyperparathyroidism (p < 0.01) accounting for CUA patients. Medication with vitamin K antagonists (p < 0.001), phosphate binders (p < 0.001), and loop diuretics (p < 0.01) was found to be associated with the onset of calciphylaxis. Hyperphosphatemia (p < 0.001), increased parathyroid hormone (p < 0.01) and triglyceride levels (p < 0.01), hypoalbuminemia (p < 0.01) and decreased hemoglobin values (p < 0.001) in the CUA cohort were significantly different from those in the NUC group. All patients with CUA received systemic medication. In contrast, only 38% (n = 8) of patients with NUC received systemic treatment. Striking discrepancies in the treatment of both cohorts were detected. In particular, NUC remains a disease pattern that is still poorly understood and differs from CUA in several important parameters.
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Affiliation(s)
- Sabine Yousuf
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dorothee Busch
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Stefan Schliep
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Cornelia Erfurt-Berge
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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2
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Misakyan N, Abu-Shanab A, Shah S. Penile Calciphylaxis: A Successfully Treated Case. Cureus 2024; 16:e54824. [PMID: 38529436 PMCID: PMC10962866 DOI: 10.7759/cureus.54824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
Penile calciphylaxis is a rare presentation of calcific uremic arteriolopathy and can be a life-threatening condition usually seen in patients with end-stage renal failure with hemodialysis. The clear etiopathogenesis of calciphylaxis is not fully understood, but it is postulated to be characterized by the accumulation of calcium in the microvessels of adipose tissue and skin, which leads to ischemia and necrosis, causing painful ulcerations, and could potentially be complicated by sepsis and mortality. End-stage renal disease (ESRD) is one of the major risk factors for penile calciphylaxis. In this report, we describe a case of a 53-year-old Hispanic male patient with ESRD and diabetes on hemodialysis, who presented with a five-day history of acute, severe, burning, non-radiating pain to the head of his penis associated with black discoloration. He was diagnosed with penile calciphylaxis and received a combination of conservative and surgical interventions, resulting in a highly positive outcome marked by complete healing of the scar without any reported complications.
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Affiliation(s)
- Narine Misakyan
- Internal Medicine, Capital Health Medical Center, Trenton, USA
| | - Amer Abu-Shanab
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Shazia Shah
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
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3
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Liang S, Guan M, Liu Z, Ruan X, Huang H, Zhong H. Sailing between scylla and charybdis-anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review. Ren Fail 2023; 45:2264401. [PMID: 37799073 PMCID: PMC10561572 DOI: 10.1080/0886022x.2023.2264401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023] Open
Abstract
Calciphylaxis is a rare and life-threatening condition in patients with end-stage kidney disease (ESKD). In this case report, we reported a 72-year-old female who had undergone aortic and mitral mechanical valve replacement 22 years ago due to rheumatic aortic and mitral stenosis. Following the valve replacement, she initiated warfarin treatment. Five years ago, she received a diagnosis of uremia and has since been undergoing regular hemodialysis. Ten months prior to her current admission, she experienced excruciating pain and was diagnosed with calciphylaxis. Additionally, an electrocardiogram revealed atrial fibrillation, while echocardiography indicated that the aortic and mitral mechanical valves were appropriately positioned, with normal perivalvular surroundings and good valve leaflet activity. No noticeable thrombosis was observed in the left atrium or left atrial appendage. Color Doppler imaging showed moderate stenosis in the lower extremity arteries, with no venous thromboembolism present. Extensive eggshell-like calcification within the arterial media was detected. The patient was managed with regular hemodialysis, symptomatic treatments (including anticoagulation and analgesia), and sodium thiosulfate. Unfortunately, symptomatic management provided limited relief, and during the one-month follow-up period, the patient passed away due to septic shock. Currently, there is insufficient conclusive evidence regarding alternative influential anticoagulants or appropriate prosthetic valve selection. For individuals with ESKD receiving maintenance hemodialysis, early identification, diagnosis, and treatment of calciphylaxis are of paramount importance.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mingjing Guan
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaomiao Ruan
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Zhong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
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4
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Zhou Y, Chen Y, Yin G, Xie Q. Calciphylaxis and its co-occurrence with connective tissue diseases. Int Wound J 2023; 20:1316-1327. [PMID: 36274216 PMCID: PMC10031236 DOI: 10.1111/iwj.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 03/23/2023] Open
Abstract
Calciphylaxis, also known as calcific uremic arteriopathy, is a rare calcification syndrome that presents as ischemic skin necrosis and severe pain. It has a high mortality rate and is characterised by calcification of the small and medium arteries and micro-thrombosis. Calciphylaxis mainly occurs in patients with end-stage renal disease. In recent years, there have been an increasing number of cases of calciphylaxis associated with connective tissue diseases. Given the absence of clear diagnostic criteria for calciphylaxis thus far, an early diagnosis is crucial for designing an effective multidisciplinary treatment plan. In this article, we review the research progress on calciphylaxis and describe its characteristics in the context of connective tissue diseases.
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Affiliation(s)
- Yueyuan Zhou
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Geng Yin
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
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5
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Liu Y, Yang C, Yang X, Xie X, Liu H, Zhang L, Ye J, Jiang D, Zhang X, Liu B. Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients. Front Med (Lausanne) 2022; 9:902171. [PMID: 35755071 PMCID: PMC9226545 DOI: 10.3389/fmed.2022.902171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Calciphylaxis is a grievous life-threatening vascular disease that commonly affects dialysis population. This is the first epidemiological survey of calciphylaxis initiated in China. Methods In the cross-sectional survey, a stratified sampling method was used to select 24 dialysis centers in Jiangsu Province. The participants were all adult patients in each center who had been on hemodialysis for more than 6 months. Calciphylaxis patients were uniformly diagnosed based on characteristic skin lesions and histopathological features. Results A total of 3,867 hemodialysis patients (average age of 55.33 ± 13.89 years; 61.81% of males) were included. Forty eight cases were diagnosed with calciphylaxis, and prevalence was 1.24%. Among calciphylaxis patients, 33 cases were male, and the average age and median dialysis duration were 53.85 ± 15.17 years and 84.00 (48.00, 138.75) months, respectively. Skin biopsy was performed in 70.83% of calciphylaxis patients, and positive rate was 64.71%. Meanwhile, the positive rate of bone scintigraphy in the diagnosis of calciphylaxis was 62.5%. The prevalence of hyperparathyroidism in case group was as high as 72.92% with longer duration, and 42.86% had undergone parathyroidectomy. Multivariate analysis indicated that increased BMI, prolonged dialysis duration, warfarin therapy, hyperparathyroidism, diabetes, tumors, low serum albumin and high serum alkaline phosphatase levels were high-risk factors for calciphylaxis. Conclusions The prevalence of calciphylaxis in Chinese hemodialysis patients was 1.24% according to regional epidemiological survey, but its actual prevalence would be presumably far beyond present data. It's urgent to improve clinical understanding of calciphylaxis, and multifaceted diagnostic methods should be applied for early screening.
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Affiliation(s)
- Yuqiu Liu
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Canlin Yang
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xin Yang
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaotong Xie
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hong Liu
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Liuping Zhang
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jianming Ye
- Department of Nephrology, The First People's Hospital of Kunshan, Suzhou, China
| | - Dongsheng Jiang
- Department of Nephrology, Taizhou People's Hospital, Taizhou, China
| | - Xiaoliang Zhang
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bicheng Liu
- Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
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Castiñeiras González J, Eiris Salvado N, Rodríguez Prieto MÁ. Usefulness of plain radiography in monitoring the treatment of calciphylaxis. Med Clin (Barc) 2021; 157:304-305. [PMID: 32819771 DOI: 10.1016/j.medcli.2020.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jose Castiñeiras González
- Servicio de Dermatología y Venereología Médico-Quirúrgica, Complejo Asistencial Universitario de León, León, España.
| | - Noemí Eiris Salvado
- Servicio de Dermatología y Venereología Médico-Quirúrgica, Complejo Asistencial Universitario de León, León, España
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7
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On the role of skin biopsy in the diagnosis of calcific uremic arteriolopathy: a case-based discussion. J Nephrol 2019; 33:859-865. [PMID: 31792896 DOI: 10.1007/s40620-019-00678-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/24/2019] [Indexed: 12/30/2022]
Abstract
Calciphylaxis is a rare disease characterized by ectopic calcification of skin arterioles resulting in ischemia, thrombosis and necrosis. Since end stage renal disease patients are those mainly affected, the term calcific uremic arteriolopathy (CUA) is also suggested. Early clinical manifestations are subtle, while overt necrotic ulcers may quickly spread and become infected so as to result in ominous outcome. Diagnosis might not be easy due to the number of other ischemic and non-ischemic skin lesions observed in uraemia. Skin biopsy, has been proposed as the diagnostic test and is often considered, but not systematically performed due to the hypothetical risk of further spreading of the lesions. Such ambiguity could be responsible for misdiagnosis or underdiagnosis. We review here five consecutive cases recorded in our Unit, all submitted to skin biopsy but with inconsistent results which generated some clinical frustration. Thus, we decided to carefully re-evaluate all of them together with pathologists and dermatologists. However, even after this ex-post discussion, we could not reach a complete agreement on the final diagnosis. In the meanwhile, papers were published in the literature that started to shed some light on the role of skin biopsy in the diagnosis of CUA.
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8
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Improvement in wound healing, pain, and quality of life after 12 weeks of SNF472 treatment: a phase 2 open-label study of patients with calciphylaxis. J Nephrol 2019; 32:811-821. [PMID: 31401795 DOI: 10.1007/s40620-019-00631-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Calciphylaxis in end-stage renal disease is characterized by painful necrotic skin ulcers and high mortality. There are no approved therapies. SNF472, an intravenous formulation of myo-inositol hexaphosphate, inhibits the formation and growth of hydroxyapatite crystals, the final common pathway in the pathogenesis of vascular calcification. METHODS In this open-label, single-arm study, calciphylaxis patients on thrice-weekly hemodialysis and standard care, received intravenous SNF472 3 times per week for 12 weeks. The primary endpoint was wound healing assessed using the quantitative Bates-Jensen Wound Assessment Tool (BWAT). Pain visual analog scale (VAS), quality of life (wound-QoL), and qualitative wound image review were secondary endpoints. Quantitative changes from baseline were analyzed by paired t-tests using multiple imputation to account for missing observations. RESULTS Fourteen patients received SNF472. Improvements from baseline to week 12 were observed for mean BWAT score (- 8.1; P < 0.001), pain VAS (- 23.6 mm; P = 0.015) and wound-QoL global score (- 0.90; P = 0.003). Of the 9 patients with ulcerated lesions at baseline who completed treatment, wound image review showed improvement for 7. SNF472 was well tolerated with no serious treatment-related adverse events. The most common adverse events were infections which occur frequently in patients on hemodialysis. None of these were considered as treatment-related. CONCLUSIONS SNF472 was well-tolerated and improvements from baseline to week 12 in wound healing, pain, and quality of life were observed. A randomized, double-blind, placebo-controlled trial is planned to evaluate SNF472 in patients with calciphylaxis.
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9
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Sammour YM, Saleh HM, Gad MM, Healey B, Piliang M. Non-uremic calciphylaxis associated with alcoholic hepatitis: A case report. World J Hepatol 2019; 11:127-132. [PMID: 30705725 PMCID: PMC6354123 DOI: 10.4254/wjh.v11.i1.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/02/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Calciphylaxis is a form of vascular calcification more commonly associated with renal disease. While the exact mechanism of calciphylaxis is poorly understood, most cases are due to end stage kidney disease. However, it can also be found in patients without kidney disease and in such cases is termed non-uremic calciphylaxis for which have multiple proposed etiologies.
CASE SUMMARY We describe a case of a thirty-year-old morbidly obese Caucasian female who had a positive history of alcoholic hepatitis and presented with painful calciphylaxis wounds of the abdomen, hips, and thighs. The hypercoagulability panel showed low levels of Protein C and normal Protein S, low Antithrombin III and positive lupus anticoagulant and negative anticardiolipin. Wound biopsy confirmed the diagnosis of non-uremic calciphylaxis in the setting of alcoholic liver disease. The calciphylaxis wounds did not improve when Sodium Thiosulfate was used alone. The patient underwent a series of bedside and surgical debridement. Broad spectrum antibiotics were also used for secondary wound bacterial infections. The patient passed away shortly after due to sepsis and multiorgan failure.
CONCLUSION Non-uremic Calciphylaxis can occur in the setting of alcoholic liver disease. The treatment of choice is still unknown.
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Affiliation(s)
- Yasser M Sammour
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Haitham M Saleh
- Department of Dermatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed M Gad
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Brayden Healey
- College of Osteopathic Medicine of the Pacific-Northwest, Western University of Health Sciences, Lebanon, OR 97355, United States
| | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland 44195, OH, United States
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10
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Abstract
Inflammatory skin diseases encompass a vast array of conditions. The field continues to expand and evolve with resurgence of conditions, through newly recognized medication adverse effects, and via more detailed descriptions of known dermatoses. The importance of clinicopathologic correlation and an up to date knowledge of dermatologic conditions cannot be overstated. This review focuses on an array of recent important developments in the histologic diagnosis of inflammatory conditions that affect the skin.
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11
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Couri T, Stier M, Mikolajczyk A, Aronsohn A. Calciphylaxis in end-stage liver and renal disease patients before and after transplant. Clin Transplant 2018; 32:e13272. [PMID: 29714030 DOI: 10.1111/ctr.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 11/29/2022]
Abstract
Calciphylaxis is a rare vascular disorder characterized by calcification of arterioles which causes tissue inflammation and necrosis. It is associated with the metabolic disturbances seen in end-stage renal disease (ESRD) and has also been described in patients with cirrhosis with preserved kidney function. Characteristic calciphylaxis lesions are black eschars surrounded by retiform purpura, and the gold standard for diagnosis is skin biopsy. Reported 1-year mortality rates range between 45% and 80%. No treatment modality has been evaluated in a prospective randomized trial, and reports of treatment efficacy vary. Kidney transplant has been reported as a successful therapy for calciphylaxis; however, cases exist of the initial onset of calciphylaxis following kidney transplant as well as simultaneous liver-kidney (SLK) transplant. The decision to maintain a patient with end-stage renal and liver disease on the waiting list for SLK transplant following the onset of calciphylaxis must consider the high 1-year mortality associated with this condition. More research is necessary to understand how to allocate donor allografts to manage patients with calciphylaxis and ESRD and/or cirrhosis effectively.
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Affiliation(s)
- Thomas Couri
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Matthew Stier
- Department of Internal Medicine Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Adam Mikolajczyk
- Department of Internal Medicine Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Andrew Aronsohn
- Department of Internal Medicine Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
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12
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Patecki M, Lehmann G, Bräsen JH, Schmitz J, Bertram A, Berthold LD, Haller H, Gwinner W. A case report of severe calciphylaxis - suggested approach for diagnosis and treatment. BMC Nephrol 2017; 18:137. [PMID: 28431568 PMCID: PMC5399827 DOI: 10.1186/s12882-017-0556-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 04/13/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Calciphylaxis is a serious complication in patients with chronic kidney disease associated mineral and bone disorder. It can occur in conditions with low and high bone turnover. So far, there are no definite diagnostic and therapeutic guidelines which may prevent the devastating outcome in many calciphylaxis patients. We report a case which clearly illustrates that knowledge of the underlying bone disorder is essential for a directed treatment. Based on this experience we discuss a systematic diagnostic and therapeutic approach in patients with calciphylaxis. CASE PRESENTATION We report a patient with severe calciphylaxis. Initial evaluation showed an elevated serum parathormone concentration and a bone-specific alkaline phosphatase activity in the upper normal range; however, the bone biopsy clearly showed adynamic bone disease. Extended dialysis with low calcium dialysate concentration and citrate anticoagulation, and administration of teriparatide led to a further increase in bone-specific alkaline phosphatase activity and most importantly, resulted in an activated bone turnover as confirmed by a second bone biopsy 11 weeks later. CONCLUSIONS This case illustrates that laboratory tests cannot reliably differentiate between high and low bone turnover in calciphylaxis patients. More importantly, this case highlights the fact that specific therapies that alter bone metabolism cannot be applied without knowledge of the bone status. On this background, we suggest that bone biopsies should be an integral part in the diagnosis and therapeutic decision in these patients and should be evaluated in further studies.
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Affiliation(s)
- Margret Patecki
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany.
| | - Gabriele Lehmann
- Division of Rheumatology/Osteology, Department of Internal Medicine III, Friedrich-Schiller-University of Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Jan Hinrich Bräsen
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany
| | - Jessica Schmitz
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany
| | - Anna Bertram
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany
| | - Lars Daniel Berthold
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany
| | - Wilfried Gwinner
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30635, Hannover, Germany
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13
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Cho H, Yi Y, Kang E, Park S, Cho EJ, Cho ST, Chun RW, Lee KE, Oh KH. Tumoral calcinosis and calciphylaxis treated with subtotal parathyroidectomy and sodium thiosulphate. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hyunjeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yongjin Yi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jin Cho
- Department of Internal Medicine, Hongseong Medical Center, Hongseong, Korea
| | - Sung Tae Cho
- Dr. Chun & Cho's Medical Clinic & Dialysis Center, Seoul, Korea
| | - Rho Won Chun
- Dr. Chun & Cho's Medical Clinic & Dialysis Center, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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14
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Biswas A, Walsh NM, Tremaine R. A Case of Nonuremic Calciphylaxis Treated Effectively With Systemic Corticosteroids. J Cutan Med Surg 2015; 20:275-8. [PMID: 26700539 DOI: 10.1177/1203475415624104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Calciphylaxis is a syndrome of systemic calcification of the arteries leading to painful tissue necrosis and ulceration. The disease has a high mortality rate with no clear etiology. There is a strong correlation of calciphylaxis with end-stage renal disease, but it can also affect people with normal renal function. Treatment of the disease has been successful at times with various modalities, but in the case of systemic corticosteroids, there is conflicting evidence. In this case report, the authors present a patient with acute nonuremic calciphylaxis who responded very positively to systemic corticosteroids.
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15
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Gupta N, Haq KF, Mahajan S, Nagpal P, Doshi B. Gastrointestinal Bleeding Secondary to Calciphylaxis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:818-22. [PMID: 26572938 PMCID: PMC4654591 DOI: 10.12659/ajcr.895164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Nancy Gupta
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Khwaja F Haq
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Bijal Doshi
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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16
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Black JM, Brindle CT, Honaker JS. Differential diagnosis of suspected deep tissue injury. Int Wound J 2015; 13:531-9. [PMID: 26123043 DOI: 10.1111/iwj.12471] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022] Open
Abstract
Deep tissue injury (DTI) can be difficult to diagnose because many other skin and wound problems can appear as purple skin or rapidly appearing eschar. The diagnosis of DTI begins with a thorough history to account for times of exposure to pressure, such as 'time down' at the scene or time during which the patient was flat and could not respond. Patients with light skin tones present with classic skin discolouration of purple or maroon tissue, a defined border around the area of injury, and often surrounding erythema is evident. Persistent erythema and hyperpigmentation, rather than blanching, should be used to determine pressure injury in dark skin tone patients. Differential diagnosis includes stage 2 pressure ulcers, incontinence-associated dermatitis, skin tears, bruising, haematoma, venous engorgement, arterial insufficiency, necrotising fasciitis and terminal skin ulcers. Many skin problems can also have a purple hue or rapidly developing eschar, and a working knowledge of dermatology is needed.
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Affiliation(s)
- Joyce M Black
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jeremy S Honaker
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, OH, USA
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