Intractable wounds caused by calcific uremic arteriolopathy treated with bisphosphonates

Hanafusa, Takaaki; Yamaguchi, Yuji; Tani, Mizuki; Umegaki, Noriko; Nishimura, Yukari; Katayama, Ichiro

doi:10.1016/j.jaad.2007.06.029

Cited by 44 publications

(35 citation statements)

References 15 publications

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“…Lowering the calcium concentration in the dialysate to 1.0-1.5 mEq/L as tolerated and intensifying dialysis to four to six times per week have been used (76,77). Bisphosphonates, both intravenous and oral preparations, have been used successfully, resulting in pain relief within days and lesion resolution within weeks (75,85,86). Although bisphosphonate use is controversial in those patients with a GFR,30 ml/min because of the potential risk of adynamic bone disease and direct nephrotoxicity (87), the benefit of decreasing morbidity and/or mortality in the case of CUA outweighs the risks.…”

Section: Metastatic Calcificationmentioning

confidence: 99%

Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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SummaryA broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options.

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Section: Metastatic Calcificationmentioning

confidence: 99%

Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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“…There have been a growing number of reports on the efficacy of bisphosphonates [12,22,23,24]. Some have proposed its mechanism is calcium-mediated and entirely due to control of high bone absorption, thus possibly being part of a combined cinacalcet, vitamin D analog and PTH-control strategy for controlling high bone turnover.…”

Section: Treatmentmentioning

confidence: 99%

“…One approach would be to consider these agents in patients with uncontrolled high bone turnover states or in those patients who do not have clinical improvement after approximately 2 weeks of STS therapy. Doses utilized have included etidronate disodium at 200 mg orally each day for 14 days [22,23], pamidronate at 30 mg intravenously (5 doses over 48 days [24] or 9 doses over approximately 3 months [25]) or alendronate at 35 mg once weekly. Clearance of bisphosphonates by hemodialysis may impact dosing schedules, but this has not been fully investigated.…”

Section: Treatmentmentioning

confidence: 99%

Evolution of Treatment Strategies for Calciphylaxis

Ross

2011

Am J Nephrol

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Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Mortality reaches 80%, due to progressive skin ischemia, necrosis and infections. In addition to calcium and parathyroid disorders, hypercoagulability can have a role: primary thrombotic disorders as well as secondary, such as proposed warfarin procoagulant effects. Traditional care addresses the calcium-phosphate-PTH axis: minimizing calcium intake, calcimimetics, cautious vitamin D analogs, strict phosphate control, and surgical parathyroidectomy if necessary. Newer approaches focus on extraosseous mineralization: dissolution of calcium deposits, altering osteoprotegerin and NF-ĸB pathways, and treating macrophage or cytokine-mediated inflammation. Sodium thiosulfate has reported success, and is thought to be due to enhanced calcium solubility and dialysis clearance. Bisphosphonates may have efficacy by lowering bone turnover or a variety of vascular tissue mechanisms. The literature for both agents is very limited, and optimal dosing regimens remain unclear. Patients responsive to a medication will have decreasing pain in days and lesions beginning to heal within approximately 2 weeks. Due to high mortality, early use of combination therapy is advocated, although specific protocols have not been well established. The often dramatic improvements in case-based literature are very encouraging and will hopefully lead to more rigorous studies.

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“…64 Since then, 5 additional patients have responded to intravenous pamidronate, intravenous ibandronate, or oral etidronate. [65][66][67][68][69] Rapid, dramatic pain relief was achieved in 3 of these 6 patients over several days. 63,65,69 Complete ulcer healing took up to 6 months.…”

Section: Bisphosphonatesmentioning

confidence: 99%