Calciphylaxis in a haemodialysis patient: functional protein S deficiency?

Perez-Mijares, R.; Guzman-Zamudio, J. L.; Payan-Lopez, J.; Rodríguez-Fernández, Ana; Gomez-Fernandez, P.; Almaraz-Jimenez, M.

doi:10.1093/oxfordjournals.ndt.a027686

Cited by 35 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent large case series of end-stage renal disease patients diagnosed with calciphylaxis 7 of 12 skin biopsies showed microvascular thrombi, suggesting an underlying thrombotic state in these cases [16]. Indeed, prothrombotic states such as protein C and S deficiencies have been described in calciphylaxis [18,19]. To date no studies have actually examined the incidence of HIT antibodies in patients diagnosed with calciphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

2001

View full text Add to dashboard Cite

Skin ulceration is a well-characterized thrombotic complication of the heparin-induced thrombocytopenia (HIT) syndrome. We present the case of a 73-year-old diabetic woman nearing end-stage renal failure who developed extensive upper thigh, abdominal and buttock ulceration following initiation of subcutaneous heparin for prophylaxis against deep vein thrombosis. A preliminary diagnosis of calciphylaxis was made based on the classical distribution and macroscopic appearance of the ulceration in a patient with end-stage renal failure and secondary hyperparathyroidism. However skin biopsy showed complete absence of calcium deposits in the dermal microvasculature. The presence of extensive microthrombi within dermal vessels prompted serologic testing to detect a prothrombotic state. We identified the combined presence of heparin-dependent platelet activating (HIT) antibodies and functional protein S deficiency. To our knowledge this is the first reported case of a dialysis patient presenting with skin ulceration induced by heparin and protein S deficiency. This case highlights the importance of a skin biopsy and testing for a hypercoaguable state in patients with end-stage renal disease and skin ulceration. We suggest that HIT antibodies should be requested in all dialysis patients presenting with skin ulceration.

show abstract

Section: Discussionmentioning

confidence: 99%

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

2001

View full text Add to dashboard Cite

show abstract

“…Calciphylaxis is a multifactorial syndrome (19)(20)(21)(22)(23)(24). In our previous case, we speculated that the administration of corticosteroids might act synergistically to cause the disease, in addition to diabetes mellitus and chronic renal failure (18).…”

Section: Discussionmentioning

confidence: 96%

Development of Proximal Calciphylaxis with Penile Involvement after Parathyroidectomy in a Patient on Hemodialysis

et al. 2004

View full text Add to dashboard Cite

Elevated parathyroid hormone (PTH) levels and hyperphosphatemia are thought to be associated with the development of calciphylaxis. We report a patient on hemodialysis who developed proximal calciphylaxis with consistently low PTH levels after parathyroidectomy. A 31-year-old man was admitted to our hospital because of abdominal skin ulcerations. Calciphylaxis spread to the penis, and simultaneous progressive lung calcification was evident on chest X-ray, suggestive of pulmonary calciphylaxis on 99m Tc-methylene disphosphonate scintigraphy. The patient died of respiratory failure despite intensive treatment including hyperbaric oxygen therapy. This is the first report of a patient on hemodialysis who developed calciphylaxis involving the penis after parathyroidectomy. (Internal Medicine 43: 63-68, 2004)

show abstract

“…Previously, it was considered that heavily calcified vessels maybe unable to reactively vasodilate to increase skin blood flow; thus, ischemic areas may develop. Perez-Mijares et al (25) reported a case of calciphylaxis in a hemodialysis patient with severe secondary HPT, severe diffuse calcification of arteries of several sizes, and functional protein S deficiency with a favorable response to treatment with low molecular weight heparin. Functional protein S deficiency can occur secondary to severe HPTand extensive vascular calcifications.…”

Section: Discussionmentioning

confidence: 99%

Calciphylaxis in a Patient with End-Stage Renal Disease Secondary to Systemic Lupus Erythematosus Associated with Acral Gangrene and Mesenteric Ischemia.

et al. 2001

View full text Add to dashboard Cite

Apatient with end stage renal disease secondary to systemic lupus erythematosus (SLE) ultimately required amputation of the four extremities and developed mesenteric ischemia. The patient presented with widespread medial calcification involving various small to mediumsized arteries, although no noticeable secondary hyperparathyroidism was observed. We speculated that SLEassociated with systemic vasculitis and uremicmilieu over a numberof years may represent the perfect preexisting condition for calcific arteriolopathy to occur following which several factors including chronic administration of corticosteroids, photosensitivity in lupus, and significant weight loss may have contributed to acral gangrene and mesenteric ischemia.

show abstract

Calciphylaxis in a haemodialysis patient: functional protein S deficiency?

Cited by 35 publications

References 0 publications

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

Development of Proximal Calciphylaxis with Penile Involvement after Parathyroidectomy in a Patient on Hemodialysis

Calciphylaxis in a Patient with End-Stage Renal Disease Secondary to Systemic Lupus Erythematosus Associated with Acral Gangrene and Mesenteric Ischemia.

Contact Info

Product

Resources

About