Calcific uremic arteriopathy in a patient with long-standing uremia and severe hyperparathyroidism

Abstract

Calcific uremic arteriopathy (CUA) is a rare complication of uremia. Its pathogenesis is not known, and there is no well-defined treatment for it. In this report we describe CUA in a patient with end-stage renal failure who had undergone hemodialysis (HD) for 12 years. The patient developed end-stage renal failure 12 years prior to this report because of chronic glomerulonephritis, and was managed by HD. He had a renal transplant soon after initiation of HD, but this graft failed within a month because of acute rejection, and HD was resumed. He became hepatitis C positive 2 years later, and tests showed the development of impaired liver function. A year prior to this report, the patient developed tubercular ascites and responded well to antituberculous drugs. Six months prior to this report he noticed the development of multiple ulcerations in his toes and digits with ischemic pain. These lesions slowly increased in number and size. The patient was managed by strictly controlling phosphorus and by anticoagulation, followed by parathyroidectomy. This led to complete healing of most ischemic lesions and improvement of others. We attribute the CUA in this patient to prolonged hyperphosphatemia and hyperparathyroidism. Control of hyperphosphatemia, parathyroidectomy, local care, and anticoagulation are important therapeutic measures for this rare but life-threatening complication of chronic uremia.