Calciphylaxis: a rare but potentially fatal event of chronic kidney disease. Case report

Marques, Sílvio Alencar; Kakuda, Aline Cruz; Mendacolli, Thais Jung; Abbade, Luciana Patrícia Fernandes; Marques, Mariângela Esther Alencar

doi:10.1590/abd1806-4841.20132280

Cited by 14 publications

(13 citation statements)

References 10 publications

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“…The first steps when a patient is identified as having calciphylaxis, that is, correcting plasma calcium and phosphorous and normalizing parathyroid hormone levels, are necessary due to the implications these imbalances cause. Sodium thiosulfate and parathyroidectomy help regulate the calcium-phosphorus product and have improved pain along with the healing of lesions [1]. Sodium thiosulfate works by chelating calcium to produce calcium thiosulfate that is studied to be more soluble and thus more easily cleared [5].…”

Section: Discussionmentioning

confidence: 99%

“…Calciphylaxis is a poorly understood disease that almost exclusively occurs in end-stage renal disease (ESRD). It has been reported in 1%-4.5% of patients with ESRD requiring hemodialysis mostly involving the lower extremities, however, penile involvement is quite rare [1]. It is characterized by the calcification of medium and small dermal arterioles with resultant gangrenous necrosis.…”

Section: Introductionmentioning

confidence: 99%

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Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Lipinski¹,

Sahu²

2020

Cureus

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Calciphylaxis is a rare and poorly understood disease that almost exclusively occurs in endstage renal disease (ESRD). It is characterized by the calcification of medium and small dermal arterioles with resultant gangrenous necrosis. Patients develop exquisitely painful skin ulceration and necrosis, typically in the lower extremities. Treatments are severely limited, and mortality is high, as few treatment options provide a survival benefit. Improvement in a few calciphylaxis cases affecting the extremities or abdomen have been reported using hyperbaric oxygen therapy (HBOT), however, very few have had a favorable response when it affected penile tissue. We present a case of a patient with ESRD on hemodialysis and subtotal parathyroidectomy who had biopsy-proven penile calciphylaxis with refractory pain who ultimately underwent successful HBOT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Lipinski¹,

Sahu²

2020

Cureus

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“…Such a case, with rapid fatal development shortly after parathyroidectomy, is presented here. The literature reports relatively few such situations, those reported generally concerning post-surgical treatment of SHPT [8,9].…”

Section: Discussionmentioning

confidence: 99%

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism after Parathyroidectomy: A Case Report

Radu

Daniealopol

Santini

et al. 2019

The Journal of Critical Care Medicine

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Introduction Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphatemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. [1] Case report This report concerns a dialysed patient who underwent surgical treatment for secondary refractory hyperparathyroidism. Haemodialysis was carried out pre-operatively, and subsequently, a total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternocleidomastoid muscle (SCM) was performed. Rapid and progressive hypocalcaemia symptoms developed during the second day postoperatively. Acute cardiac symptoms with tachyarrhythmia, haemodynamic instability and finally asystole occurred, which required cardiopulmonary resuscitation (CPR). The ionic calcium level was 2.2 mg/dL being consistent with a diagnosis of HBS. A second cardiac arrest unresponsive to CPR followed an initial period of normal sinus rhythm. Death ensued shortly after. Before death, the ionic calcium was 3.1 mg/dL. Conclusion HBS, after parathyroidectomy in patients with secondary hyperparathyroidism (SHPT), may be severe, prolonged and sometimes fatal. Generally, HBS symptomatology is that of a mild hypocalcaemia. It can, however, include heart rhythm disturbances with haemodynamic alterations requiring intensive care measurements and even cardiopulmonary resuscitation. A close clinical and laboratory post-parathyroidectomy monitoring of dialysed patients is of the utmost importance.

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“…In this article, a hypothetical case study of a patient with ESRD, who is on dialysis and developed calciphylaxis of both lower limbs, is discussed [2]. Also, despite being a popular management option, the current declining trend of SPKT in modern healthcare, the future prospects, and financial implications of SPKT will be discussed.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Pancreas-Kidney Transplant: A Positive Stimulus in the Medical World

Ali

Khan

2020

Cureus

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Kidneys are one of the essential organs of our body, with chronic kidney disease being a very prevalent and emotionally, mentally and physically straining condition affecting 1 in 15 people worldwide. The prevalence is further escalating with every passing year. It is slowly progressive in nature, and many times goes unnoticed until symptoms start manifesting and presenting themselves much later in life. In this article, end-stage renal disease (ESRD) due to diabetes mellitus and its effect on different organs is examined, along with the role of simultaneous pancreas-kidney transplant (SPKT) in the management of this condition. Although proven to be an assured treatment with an outstanding allograft acceptance rate, the fact that it is still not widely adopted in many healthcare setups due to financial implications is also studied. Online databases such as PubMed and Google Scholar were searched for the purpose of data collection; due to the very limited number of randomized controlled trials conducted on this given topic, a limited discussion was retrieved. By applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method and several inclusion/exclusion criteria, approximately 66 articles were assessed for eligibility based on the title and abstract. A total of 44 articles were shortlisted and considered in the final review. Several systematic reviews that have been conducted in the past reveal the importance of SPKT at an early stage of diagnosis towards increasing longevity of the patient with freedom from multiple medications. Transplant is a cost-effective therapy when compared to the prolonged dependence on dialysis, insulin pens, and increased susceptibility to infections. A greater number of specialists must also train to carry out SPKT and identify the early stages of ESRD, and medical centers should be encouraged to carry out transplant procedures effectively both financially and medically. This can be achieved through the development of global policy mechanisms and establishment of universally adoptable standards.

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Calciphylaxis: a rare but potentially fatal event of chronic kidney disease. Case report

Cited by 14 publications

References 10 publications

Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism after Parathyroidectomy: A Case Report

Simultaneous Pancreas-Kidney Transplant: A Positive Stimulus in the Medical World

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