Calciphylaxis associated with acute, reversible renal failure in the setting of alcoholic cirrhosis

Chavel, Severine M; Taraszka, Karen S; Schaffer, Julie V.; Lazova, Rossitza; Schechner, Jeffrey S.

doi:10.1016/j.jaad.2003.11.050

Cited by 25 publications

(29 citation statements)

References 40 publications

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“…These included 27 individual case reports (3,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32) and four case series (4,6,26,33). A summary of the literature search strategy is provided in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Primary hyperparathyroidism (4,7,19,24,27,29,33), connective tissue diseases (6,20,28), alcoholic liver disease (9,11,13,14,16,22), and malignancies (5,15,17,21,23,30,31) were the most common causes of NUC (Table 1). Diabetes (26), chemotherapy-induced (cyclophosphamide, Adriamycin, and fluorouracil) protein C and S deficiency (18), Crohn disease (3), POEMS syndrome (12), vitamin D deficiency (10), weight loss (25), chronic kidney disease (not ESKD) (32), and osteomalacia treated with nadroparin calcium (8) were the remaining reported etiologic conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Diabetes (26), chemotherapy-induced (cyclophosphamide, Adriamycin, and fluorouracil) protein C and S deficiency (18), Crohn disease (3), POEMS syndrome (12), vitamin D deficiency (10), weight loss (25), chronic kidney disease (not ESKD) (32), and osteomalacia treated with nadroparin calcium (8) were the remaining reported etiologic conditions. In 22 cases, corticosteroid use was an associated predisposing factor (3,6,7,12,13,20,21,23,28,30,33), warfarin use was reported in nine cases (5,6,31), albumin or blood transfusions were reported in seven cases (4,9,(12)(13)(14)(15)19), and protein C or S deficiency was reported in four cases (9,16,18,20). Precipitating trauma leading to cutaneous lesions was reported in only two cases (10,21).…”

Section: Resultsmentioning

confidence: 99%

“…Precipitating trauma leading to cutaneous lesions was reported in only two cases (10,21). Diabetes as an associated condition (not as a primary cause of NUC) was reported in eight cases (5,9,10,15,24,27,31).…”

Section: Resultsmentioning

confidence: 99%

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Calciphylaxis from Nonuremic Causes

Nigwekar

Wolf²,

Sterns

et al. 2008

Clinical Journal of the American Society of Nephrology

370

396

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Background and objectives: Calciphylaxis, or calcific uremic arteriolopathy, is a well-described entity in end-stage kidney disease and renal transplant patients; however, little systematic information is available on calciphylaxis from nonuremic causes. This systematic review was designed to characterize etiologies, clinical features, laboratory abnormalities, and prognosis of nonuremic calciphylaxis.Design, setting, participants, & measurements: A systematic review of literature for case reports and case series of nonuremic calciphylaxis was performed. Cases included met the operational definition of nonuremic calciphylaxis-histopathologic diagnosis of calciphylaxis in the absence of end-stage kidney disease, renal transplantation, or acute kidney injury requiring renal replacement therapy.Results: We found 36 cases (75% women, 63% Caucasian, aged 15 to 82 yr) of nonuremic calciphylaxis. Primary hyperparathyroidism, malignancy, alcoholic liver disease, and connective tissue disease were the most common reported causes. Preceding corticosteroid use was reported for 61% patients. Protein C and S deficiencies were seen in 11% of patients. Skin lesions were morphologically similar to calcific uremic arteriolopathy. Mortality rate was 52%, with sepsis being the leading cause of death.Conclusion: Calciphylaxis should be considered while evaluating skin lesions in patients with predisposing conditions even in the absence of end-stage kidney disease and renal transplantation. Nonuremic calciphylaxis is reported most often in white women. Mineral abnormalities that are invoked as potential causes in calcific uremic arteriolopathy are often absent, suggesting that heterogeneous mechanisms may contribute to its pathogenesis. Nonuremic calciphylaxis is associated with high mortality, and there is no known effective treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Calciphylaxis from Nonuremic Causes

Nigwekar

Wolf²,

Sterns

et al. 2008

Clinical Journal of the American Society of Nephrology

370

396

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“…It is unknown whether the CMV mechanisms implied in other vasculitis processes such as direct cell injury, immunemediated injury and/or increase pro-coagulant activity, could be responsible for the endothelial damage observe in CUA. Few cases of CUA have been reported in patients with liver disease (11)(12)(13)(14)(15)(16)(17). In those reports, CUA present in patients with alcoholic cirrhosis and normal renal function; only one patient had acute kidney injury (17).…”

Section: Discussionmentioning

confidence: 99%

Calciphylaxis in Simultaneous Liver–Kidney Transplantation

Bohórquez

Chamorro

Garces

et al. 2015

American Journal of Transplantation

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We present four patients who underwent simultaneous liver-kidney transplantation (SLK) and were diagnosed with calciphylaxis, also known as calcific uremic arteriolopathy (CUA). Common characteristics included high MELD scores (mean 35.2 AE 4.8) and advanced renal disease (duration range 6-44 weeks). CUA was diagnosed within the first 2 months post-SLK based on clinical features. Severe morbidity and prolonged hospital stay were observed and one of the patients died secondary to sepsis. Treatment included metabolic support, wound care, calcium level correction and use of sodium thiosulphate. CUA should be considered in the presence of painful dermatologic changes in patients status post SLK.

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Calciphylaxis With Normal Renal and Parathyroid Function

Kalajian¹,

Malhotra²,

Callen³

et al. 2009

Arch Dermatol

105

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Background: Calciphylaxis is a life-threatening form of metastatic calcification-induced microvascular occlusion syndrome. Although traditionally observed in patients with end-stage renal disease and/or hyperparathyroidism, the development of calciphylaxis in "nontraditional" patients having both normal renal and parathyroid function has been reported. However, to date there has been no collective analysis identifying common patient characteristics potentially predisposing to the development of calciphylaxis in nontraditional patients.Observations: A 58-year-old woman with endometrial carcinoma developed extensive calciphylaxis despite the presence of normal renal and parathyroid function. The disease resolved with rapid diagnosis, supportive therapy, and medical management. Analysis of this case and the 13 previously reported cases of nontraditional calciphylaxis identified the following patient characteristics that highlight clinical situations potentially predisposing to calciphylaxis: hypoalbuminemia, malignant neoplasm, systemic corticosteroid use, anticoagulation with warfarin sodium or phenprocoumon, chemotherapy, systemic inflammation, hepatic cirrhosis, protein C or S deficiency, obesity, rapid weight loss, and infection.Conclusions: Calciphylaxis is becoming increasingly common in patients with normal renal and parathyroid function. The observations from this study may assist dermatologists in the rapid diagnosis and prompt initiation of therapy for this devastating disease.

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Calciphylaxis associated with acute, reversible renal failure in the setting of alcoholic cirrhosis

Cited by 25 publications

References 40 publications

Calciphylaxis from Nonuremic Causes

Calciphylaxis from Nonuremic Causes

Calciphylaxis in Simultaneous Liver–Kidney Transplantation

Calciphylaxis With Normal Renal and Parathyroid Function

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