Benign nodular calcification and calciphylaxis in a haemodialysed patient

Abstract

Several types of soft tissue calcification can be detected from radiographic evaluation of patients with end-stage renal failure. The factors that predispose to such calcification include an increase in CaxP product in serum, the degree of secondary hyperparathyroidism, the level of blood magnesium, the degree of alkalosis, and the presence of local tissue injury. Three major varieties include calcification of medium-sized arteries, periarticular or tumoral calcification and visceral calcification. Calciphylaxis is a phenomenon consisting of acute ischemic necrosis in presence of calcification of dermohypodermic arterioles. It occurs mostly in chronic renal failure patients with secondary or tertiary hyperparathyroidism with a persistently elevated calcium-phosphorus product. There are few options in treating calciphylaxis and the outcome is generally poor. The authors report the case of a haemodialised patient with benign nodular calcification and calciphylaxis. The coexistence of both entities in the same patient has never been described.

Cutaneous necrosis by calcific uremic arteriolopathy

“…Other findings related to a severe reduction in blood flow are endovascular fibrosis, massive calcification of arterioles, and thrombus formation within venules. 2 In the histopathology of our patients, we observed calcification of the medium zone of the vessel walls in the elastic lamina with intimal hyperplasia. The calcium localized in the medium and intimal lamina occluded the vascular lumen.…”

“…10 -13 The appearance of CUA in other entities associated with hypercalcemia, such as primary hyperparathyroidism, vitamin D intoxication, milk-alkali syndrome, idiopathic neonatal hypercalcemia, and hematologic malignancies, is less frequent. 2,12,14 The hallmark of this condition is the calcification and intimal hypertrophy of small vessels, in association with fat necrosis and infiltration of neutrophils, lymphocytes, and macrophages. Other findings related to a severe reduction in blood flow are endovascular fibrosis, massive calcification of arterioles, and thrombus formation within venules.…”

“…Sometimes it is necessary to perform a large elliptical biopsy because the histologic findings are segmental and often misdiagnosed. 2,28 The differential diagnosis includes atheroemboli, vasculitis, panniculitis, cryofibrinogenemia, cryoglobulinemia, Weber-Christian syndrome, and hyperoxaluria. 1,19,[29][30][31] The optimal treatment is controversial and there are few options.…”

“…It is commonly observed in patients with chronic renal failure undergoing hemodialysis or in those with a failing renal transplant. [1][2][3] The first report on the condition was written in 1898 by Bryant and White. 4 In 1962, Selye et al .…”

Uraemic gangrene syndrome: is parathyroidectomy always necessary?

“…The aim of treatment is to normalize the abnormal serum Ca, P and PTH levels. Selective parathyroidectomy appears to be the most effective method according to several reports 3,4,6–9 . Some authors even suggest prophylactic removal of the parathyroid glands when vascular calcification becomes evident 4 .…”