Calciphylaxis

Ng, Angie T.; Peng, David H.

doi:10.1111/j.1529-8019.2011.01401.x

Cited by 45 publications

(60 citation statements)

References 90 publications

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“…La calcifilaxis es una condición poco frecuente pero devastadora que puede llevar a un compromiso no solo de la piel sino de músculo, fascia y órganos internos, causando isquemia y necrosis de estos tejidos por depósito de calcio en los vasos de pequeño y mediano calibre (1).…”

Section: Introductionunclassified

Calcifilaxis como complicación cutánea en paciente con insuficiencia renal crónica en diálisis

2013

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ResumenLa calcifilaxis generalmente hace referencia a una enfermedad caracterizada por lesiones violáceas reticuladas dolorosas que progresan a necrosis, de predominio en miembros inferiores, en pacientes con falla renal especialmente que se encuentran en manejo con hemodiálisis, tiene una mortalidad que en algunos estudios alcanza hasta el 80%. Hay una mayor incidencia de eventos cardiovasculares en estos pacientes. Presentamos el caso de una paciente con calcifilaxis secundaria a insuficiencia renal crónica, en la que se resalta el alto grado de mortalidad de la enfermedad.Palabras clave: Calcifilaxis, falla renal, calcificación metastásica. CALCIPHYLAXIS SKIN AS A COMPLICATION IN PATIENTS WITH CHRONIC RENAL DIALYSIS AbstractCalciphylaxis usually refers to a disease characterized by reticulated violet lesions painful to touch which progress to necrosis and predominate in lower extremities in patients diagnosed with renal failure and who are being managed with hemodialysis. This disease has a high mortality rate that in some studies reaches up to 80%. There is an increase in cardiovascular events in these patients. We present the case of a patient who is diagnosed with calciphylaxis secondary to chronic renal failure, in which we highlight the elevated rate of mortality secondary to this disease.Key words: Calciphylaxis, renal failure, metastatic calcification. CALCIFILAXIA COMO COMPLICAÇÃO CUTÂNEA EM PACIENTE COM INSUFICIÊNCIA RENAL CRÔNICA EM DIÁLISE ResumoA calcifilaxia geralmente faz referência a uma doença caracterizada por lesões violáceas reticuladas dolorosas que progridem a necrose, de predomínio em membros inferiores, em pacientes com falha renal especialmente que se encontram em manejo com hemodiálise, tem uma mortalidade que em alguns estudos atinge até o 80%. Há uma maior incidência de eventos cardiovasculares em estes pacientes. Apresentamos o caso de uma paciente com calcifilaxia secundaria a insuficiência renal crônica, na que se resalta a alta série de mortalidade da doença.Palavras chave: Calcifilaxia, falha renal, calcificação metastática.REVISTA 21 (1): 87-92, 2013

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Section: Introductionunclassified

Calcifilaxis como complicación cutánea en paciente con insuficiencia renal crónica en diálisis

2013

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“…There is intimal hyperplasia with partial obliteration of the vessel lumen. Fibrin thrombi are often noted and are in close proximity to epidermal and dermal necrosis with necrosis frequently extending into the subcutaneous tissue (12).…”

Section: Diagnosismentioning

confidence: 99%

Painful Skin Ulcers in a Hemodialysis Patient

Sprague

2014

Clinical Journal of the American Society of Nephrology

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SummaryCalciphylaxis, also referred to as calcific uremic arteriolopathy, is a relatively rare but well described syndrome that occurs most commonly in patients with late stage CKD. It is characterized by very painful placques or subcutaneous nodules and violaceous, mottled skin lesions that may progress to nonhealing ulcers, tissue necrosis, and gangrene with a 1-year mortality rate >50%. The pathogenesis of calciphylaxis is poorly understood. Risk factors include female sex, obesity, hyperphosphatemia, hypercalcemia, hyperparathyroidism, longer dialysis vintage, hypercoagulable states, and use of calcium-containing phosphate binders and warfarin. Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Therapy is generally focused on correcting disturbances of calcium, phosphorus, and parathyroid hormone metabolism. Additional therapy focuses on decreasing inflammation and on dissolution of tissue calcium deposits with sodium thiosulfate and/or bisphosphonates. Successful treatment generally results in improvement of pain and healing of the lesions within 2-4 weeks, but the disorder generally takes many months to completely resolve.Clin J Am Soc Nephrol 9: 166-173, 2014. doi: 10.2215/CJN.00320113Case Description Abhijit Naik, MD (Renal Fellow). A 54-year-old white man was referred from an outside dialysis clinic for evaluation of necrotic skin lesions. He had a 10-year history of diabetes and hypertension, with ESRD secondary to diabetes. His history was also significant for coronary artery disease, with two prior myocardial infarctions and atrial fibrillation. He had been undergoing thrice-weekly hemodialysis for 2 years with a Kt/V between 1.3-1.4. Three months before presentation he noticed several small firm and very painful nodules on both anterior thighs. He stated that after several weeks the lesions became much larger, black, and spread to the lateral thighs and buttocks. He was treated with mupirocin ointment and a vascular evaluation revealed normal blood flow in his legs. Aside from these painful lesions, he stated that he generally felt "ok." Dialysis had been proceeding without problems. He denied chest pain, dyspnea, abdominal pain, or any gastrointestinal complaints. Review of systems was otherwise unremarkable. He never smoked and drank alcohol very infrequently. Medications included aspirin, amiodarone, simvastatin, famotidine, glipizide, clopidogrel, sevelamer carbonate, hydrocodone, and gabapentin. He had no known allergies.On examination his vital signs were as follows: temperature, 98.8°F; heart rate, 80 beats per minute; BP, 94/60 mmHg, with no orthostatic changes; and respiratory rate, 20 breaths per minute. His BP was generally low, with systolic BP averaging between 90 and 100 mmHg. He was an ill appearing male in mild distress from extremity pain. His lungs were clear and a cardiovascular examination revealed a regular rate and rhythm with a 2/6 holosystolic murmur. His abdomen had normal bowel sounds and was mildly distended with some asc...

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“…Other calciphylaxis risk factors include female sex, and obesity or significant weight loss, with the latter two working via effects on fibroelastic septae [2,3,8]. These septae traverse the subcutaneous fat from the deep fascia to the dermis, functioning to anchor the skin to the body, support the adipose tissue, and provide scaffolding for blood vessels that are attached to and incorporated within the septae.…”

Section: Citation: Higgins S Hu M Worswick S Binder S (2016) Calcimentioning

confidence: 99%

“…Targeted molecular therapies may also play a role in treatment or prevention. Two possible molecular targets include Fetuin-A and Matrix Gla, both of which act as vascular calcification inhibitors [3]. Maintenance of hemoglobin between 9.5 and 10.5 g/dL with transfusion rather than erythropoiesis-stimulating agents should also be attempted.…”

mentioning

confidence: 99%

“…Hyperbaric therapy counteracts tissue hypoxia by providing high concentrations of oxygen. It also reduces the risk of infection by providing oxygen necessary for the formation of bactericidal free oxygen radicals [3]. Sodium thiosulfate is the most common therapy and is noted to work as an anticalcification agent by binding calcium and thereby increasing solubility of calcium deposits to enhance their hemodialysis clearance [4].…”

mentioning

confidence: 99%

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