Early onset calciphylaxis following acute kidney injury secondary to anti-glomerular basement membrane antibody disease

Abstract

Calciphylaxis is commonly associated with end-stage renal disease (ESRD) and renal transplant. We present a rare case of early onset calciphylaxis in a patient presenting with acute kidney injury (AKI) secondary to anti-glomerular basement membrane (anti-GBM) antibody disease. A 65-year-old obese Caucasian woman with type 2 diabetes mellitus and hypertension presented with a 1-month history of painless gross haematuria and worsening lower extremity oedema. Laboratory results indicated AKI and nephrotic-range proteinuria. Anti-glomerular antibodies were elevated. Renal biopsy revealed focal crescentic glomerulonephritis with linear capillary immunoglobulin G staining consistent with anti-GBM antibody disease. She was treated with haemodialysis, plasmapheresis, steroids, bumetanide and cyclophosphamide. Two months later, she developed necrotic lesions on bilateral thighs. Wound biopsy was consistent with calciphylaxis. This case highlights that calciphylaxis, usually seen in patients with chronic kidney disease or ESRD, can manifest in patients with AKI as well.

Calciphylaxis and Kidney Disease: A Review

“…[11][12][13][14][15][16] A case report described the appearance of calciphylaxis in the bilateral thighs of a woman three months after developing painless hematuria and nephrotic-range proteinuria in the setting of anti-GBM disease. 17 Furthermore, a population of non-uremic (nontraditional) patients may develop calciphylaxis despite normal kidney and parathyroid function. 18,19 Non-nephrogenic calciphylaxis is associated with decreased mortality when compared to uremic calciphylaxis.…”

Calciphylaxis in a Patient With Lupus Nephritis and Acute Kidney Injury: A Rare Case Report and Literature Review

“…2,11 Limited cases have been reported on calciphylaxis in patients with AKI due to decompensated alcoholic cirrhosis or severe clinical conditions such as necrotizing fasciitis who undergo dialysis, ranging from 29 to 65 years. [13][14][15][16][17] However, there are no documented reports of patients with lupus neph ritis with significant kidney damage who had calciphylaxis.…”