Pathogenesis of calciphylaxis: Hans Selye to nuclear factor κ-B

Weenig, Roger H.

doi:10.1016/j.jaad.2007.12.006

Cited by 165 publications

(184 citation statements)

References 139 publications

(103 reference statements)

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“…Metabolic factors, systemic inflammation, oxidative stress, and endothelial injury along with certain triggers have been implicated. Risk/triggering factors include local trauma, women (73,74), Caucasian ethnicity (75), hypoalbuminemia (72,74,75), therapy with calcium salts, vitamin D supplements, erythropoiesis-stimulating agents (69,70,76), warfarin (72)(73)(74)77), and iron supplements (78). Other independent risk factors include obesity (body mass index.30 kg/m 2 ) (69,73,74), liver disease (69,79), and systemic corticosteroids (65,69,73,74).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…The low-flow rate within cutaneous vessels, combined with luminal narrowing, leads to decreased blood flow and can cause blood stasis (73). It creates a procoagulant state in the narrowed vessels, which increases the risk of thrombus formation and can lead to localized tissue ischemia and necrosis (73,76). The relationship between the implicated etiologic factors in CUA and its pathogenesis is schematically represented in Figure 5.…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…| Pathophysiology of calcific uremic arteriolopathy. Nuclear factor kb (NFkb), a transcription factor involved in the production of cytokines and inflammatory mediators, the receptor activator of NFkb (RANK), and its ligand are vital for bone mineral resorption and development (68,73,76). They can be activated by chronic inflammatory states, parathyroid hormone (PTH), aluminum, corticosteroids, free radicals, and infectious agents (73,76).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…Osteoprotegerin (OPG) is an antagonist of RANKL. RANK/RANKL and OPG are expressed on endothelial cells, osteoblasts/osteoclasts, and vascular smooth muscle cells (VSMCs) (73,76). Transformation of VSMCs into osteoblast-like cells is initiated by metabolic disturbances (particularly hyperphosphatemia), reactive oxygen species (ROS), and decrease of local vascular calcification inhibitors, such as matrix g-carboxy-glutamate protein (MGP), a vitamin K-dependent protein (68,76).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…Progressive subintimal fibrosis and medial-arteriolar calcification lead to endothelial injury and luminal narrowing. The low-flow rate within the cutaneous vessels combined with luminal narrowing leads to decreased blood flow and may lead to blood stasis (73). Systemic inflammation also causes endothelial dysfunction.…”

Section: Metastatic Calcificationmentioning

confidence: 99%

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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%

Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

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Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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Retrospective Analysis of Tissue Plasminogen Activator as an Adjuvant Treatment for Calciphylaxis

el-Azhary¹,

Arthur²,

Davis³

et al. 2013

JAMA Dermatol

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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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Pathogenesis of calciphylaxis: Hans Selye to nuclear factor κ-B

Cited by 165 publications

References 139 publications

Cutaneous Manifestations of ESRD

Cutaneous Manifestations of ESRD

Retrospective Analysis of Tissue Plasminogen Activator as an Adjuvant Treatment for Calciphylaxis

Calciphylaxis With Normal Renal and Parathyroid Function

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