Raman spectroscopy for label-free identification of calciphylaxis

Lloyd, William R.; Agarwal, Shailesh; Nigwekar, Sagar U.; Esmonde-White, Karen A.; Loder, Shawn; Fagan, Shawn P.; Goverman, Jeremy; Olsen, Bjørn R.; Jumlongras, Dolrudee; Morris, Michael D.; Levi, Benjamin

doi:10.1117/1.jbo.20.8.080501

Cited by 12 publications

(8 citation statements)

References 24 publications

(22 reference statements)

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“…Using mass spectrometry, Amuluru et al 19 showed that tissue samples from 12 CUA patients had high iron and aluminum contents, suggesting a role of metal deposition in CUA pathogenesis. Using microcomputed-tomography and Raman spectroscopy, Lloyd et al 20 confirmed the presence carbonated apatite in debrided CUA tissues from 6 patients. However, those studies included small numbers of samples and performed only chemical analyses.…”

Section: Discussionmentioning

confidence: 97%

Localization, Morphologic Features, and Chemical Composition of Calciphylaxis-Related Skin Deposits in Patients With Calcific Uremic Arteriolopathy

et al. 2019

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; for the Groupe Angio-Dermatologie of the French Society of Dermatology IMPORTANCE Calcific uremic arteriolopathy (CUA), a rare, potentially fatal, disease with calcium deposits in skin, mostly affects patients with end-stage renal disease who are receiving dialysis. Chemical composition and structure of CUA calcifications have been poorly described. OBJECTIVES To describe the localization and morphologic features and determine the precise chemical composition of CUA-related calcium deposits in skin, and identify any mortality-associated factors. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter cohort study was conducted at 7 French hospitals including consecutive adults diagnosed with CUA between January 1, 2006, and January 1, 2017, confirmed according to Hayashi clinical and histologic criteria. Patients with normal renal function were excluded. For comparison, 5 skin samples from patients with arteriolosclerosis and 5 others from the negative margins of skin-carcinoma resection specimens were also analyzed. MAIN OUTCOMES AND MEASURES Localization and morphologic features of the CUA-related cutaneous calcium deposits were assessed with optical microscopy and field-emissionscanning electron microscopy, and the chemical compositions of those deposits were evaluated with μ Fourier transform infrared spectroscopy, Raman spectroscopy, and energy dispersive radiographs. RESULTS Thirty-six patients (median [range] age, 64 [33-89] years; 26 [72%] female) were included, and 29 cutaneous biopsies were analyzed. Calcific uremic arteriolopathy and arteriolosclerosis skin calcifications were composed of pure calcium-phosphate apatite. Calcific uremic arteriolopathy vascular calcifications were always circumferential, found in small to medium-sized vessels, with interstitial deposits in 22 (76%) of the samples. A thrombosis, most often in noncalcified capillary lumens in the superficial dermis, was seen in 5 samples from patients with CUA. Except for calcium deposits, the vessel structure of patients with CUA appeared normal, unlike thickened arteriolosclerotic vessel walls. Twelve (33%) patients died of CUA. CONCLUSIONS AND RELEVANCE Calcific uremic arteriolopathy-related skin calcifications were exclusively composed of pure calcium-phosphate apatite, localized circumferentially in small to medium-sized vessels and often associated with interstitial deposits, suggesting its pathogenesis differs from that of arteriolosclerosis. Although the chemical compositions of CUA and arteriolosclerosis calcifications were similar, the vessels' appearances and deposit localizations differed, suggesting different pathogenetic mechanisms.

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Section: Discussionmentioning

confidence: 97%

Localization, Morphologic Features, and Chemical Composition of Calciphylaxis-Related Skin Deposits in Patients With Calcific Uremic Arteriolopathy

et al. 2019

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“…Skin biopsy is the current gold standard for diagnosis; however, future studies are needed to establish histological diagnostic features and careful risk–benefit assessment is needed [2,29]. There are also recent preliminary reports of noninvasive diagnostic modalities (nuclear bone scan, mammography, X-ray, computed tomography, ultrasound, and Raman spectroscopy) that need future investigation [30–33]. …”

Section: Diagnosismentioning

confidence: 99%

Calciphylaxis

Nigwekar¹

2017

Current Opinion in Nephrology and Hypertension

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Purpose of review Calciphylaxis remains a poorly understood vascular calcification disorder with predilection for patients with end-stage renal disease (ESRD). Recent data from large patient registries and databases have begun to provide information regarding incidence, risk factors, and outcomes in patients with calciphylaxis. Recent findings The most recent estimate places the incidence of calciphylaxis at 3.5 new cases/1000 patient-years among the patients with ESRD on chronic hemodialysis. It is possible that misdiagnosis or subclinical disease may attribute to lower than the true incidence. There is a suggestion that the incidence is higher in peritoneal dialysis patients compared with patients with hemodialysis. Recent studies have identified a number of risk factors and point to the effects of vitamin K deficiency mediated impairment in Matrix Gla Protein carboxylation as one of the likely pathogenic mechanisms. The outcomes in calciphylaxis patients remain poor with mortality approaching 30% at 6 months and 50% at 12 months. Summary The present review describes recent literature in the field of calciphylaxis. Calciphylaxis registries and specimen biorepositories promise to provide insights into the pathogenesis of calciphylaxis and will pave the way for much needed clinical trials.

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“…Spectra must be collected in <2 s and ideally, no more than 1 s. With rapid measurements it is easy to map the wound area and characterize wound margins for treatment and debridement. [29]…”

Section: Introductionmentioning

confidence: 99%

Calciphylaxis and its diagnosis: A review

Baby¹,

Upadhyay²,

Joseph³

et al. 2019

J Family Med Prim Care

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Calciphylaxis also known as Calcific uremic arteriolopathy (CUA), is a rare fatal complication usually associated with end-stage renal disease (ESRD). It is characterized by skin ulceration and necrosis leading to significant pain. The disease calciphylaxis is pathological state resulting in accumulation of calcium content in medial wall of small blood vessels along with the fibrotic changes in intima. The aetiopathogenesis of this disease, small vessel vasculopathy, remains complicated, and unclear. It is believed that development of calciphylaxis depends on medial calcification, intimal fibrosis of arterioles and thrombotic occlusion. The disease is rare, life-threatening medical condition that occurs mostly in population with kidney disease or in patients on dialysis. Skin biopsy and radiographic features are helpful in the diagnosis of calciphylaxis, but negative results do not necessarily exclude the diagnosis. This article highlights steps undertaking in the diagnosis of calciphylaxis.

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Raman spectroscopy for label-free identification of calciphylaxis

Cited by 12 publications

References 24 publications

Localization, Morphologic Features, and Chemical Composition of Calciphylaxis-Related Skin Deposits in Patients With Calcific Uremic Arteriolopathy

Localization, Morphologic Features, and Chemical Composition of Calciphylaxis-Related Skin Deposits in Patients With Calcific Uremic Arteriolopathy

Calciphylaxis

Calciphylaxis and its diagnosis: A review

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