Fulminant Calcinosis in Two Patients after Kidney Transplantation

Abstract

The first patient had total parathyroidectomy (PTX) with autografting 2 years before. She developed disabling soft-tissue calcifications following kidney transplantation. After reduction of the autograft – a complete removal was not possible – the subcutanous calcifications regressed. In the second patient, fulminant necrotizing vascular calcinosis developed after successful renal transplantation. Total PTX without autotransplantation was carried out, and progression of the vascular disease was ceased. In both patients, the parathyroid hormone was elevated but not the calcium-phosphate product. We suggest that fulminant calcinosis in patients with kidney transplants requires PTX.

Severe Calciphylaxis in a Renal Patient on Long-Term Oral Anticoagulant Therapy

“…Therefore, a hypercoagulability state due to acquired pro tein C deficiency has been suggested to play a role in calci phylaxis [12], In our patient, however, hypercoagulability and local thrombosis seem unlikely to have played a cau sal role for two reasons: (1) the patient was on long-term oral anticoagulant therapy with coagulation tests within the desired range (Quick test 20-35%) when she devel oped calciphylaxis and skin necrosis, and (2) the dramatic improvement after PTX emphasizes the importance of high PTH levels as probably the most relevant pathogenic factor in this case of calciphylaxis. The beneficial effect of PTX has also been observed in numerous other patients with calciphylaxis and hyperparathyroidism [8,9,16,19], In addition to elevated PTH levels, further predisposing factors in our patient may have included poor renal trans plant function requiring hemodialysis (azotemia) and ad ministration of cyclosporine A and prednisolone, albeit the prednisolone dosis was low (5 mg/day). The resump tion of hemodialysis 1 week after the onset of pruritus and painful dysesthesia might have aggravated tissue calcifi cation by correcting metabolic acidosis.…”

“…Calciphylaxis has been observed in patients with renal allografts whose serum creatinine levels were normal or close to normal and in patients with primary hyperpara thyroidism without underlying renal disease [8,11,19].…”

Acute Respiratory Failure due to ‘Pulmonary Calciphylaxis’ in a Maintenance Haemodialysis Patient

“…Characteristic calcification of arterioles of the epidermis was not found in this case. The steroid therapy, which has been reported in several cases of calciphylaxis, was not undertaken in this patient either [11]. …”

Prevenção e tratamento do hiperparatireoidismo secundário na DRC

“…Calciphylaxis is associated with a high mortality rate, especially when the trunk is involved, as opposed to the expectation of a better prognosis when the involvement is limited to the extremities. 46 The mechanisms potentially involved are many, 47 and the risk factors already described are: female gender, deficit of antithrombin III and/or protein C or S, 48 use of corticosteroids, 49 immunosuppressors, 50 oral anticoagulant, 51 estrogens, 52 intravenous iron overload, 53 smoking, diabetes mellitus, heart failure, morbid obesity, malnutrition, 54 dyslipidemia, losing weight, local traumas, and severe clinical settings such as sepsis, endocarditis, hepatic cirrhosis, and processes with a subjacent immunologic basis. 55 The laboratory evaluation generally demonstrates an increase in PTH.…”