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

Abstract

The pathogenesis of calciphylaxis, a potentially life-threatening condition, is not well understood. Several factors such as end-stage renal disease (azotemia), hyperparathyroidism, hyperphosphatemia, hypercalcemia, a high calcium-phosphate product, and the use of steroids and cytotoxic drugs after kidney transplantation are believed to interact in calciphylaxis. Recently, hypercoagulability due to functional protein C deficiency has been suggested to play a pathogenic role in this condition. Here, we present a renal transplant patient, with secondary hyperparathyroidism and on long-term oral anticoagulant therapy, who developed calciphylaxis with severe skin necrosis of her legs. The patient’s condition improved dramatically after total parathyroidectomy. Hypercoagulability, therefore, does not appear to have played a significant role in this case of calciphylaxis.

Chronic Kidney Disease

“…However, although warfarin and hypercoagulability have both been implicated, the latter on the basis of an association of protein C deficiency and calciphylaxis, some studies suggest that neither hypercoagulability nor warfarin play a role in this rare condition. 99 Similarly, parathyroidectomy has been reported to lead to the resolution of the skin ulcers of calciphylaxis in some series 100 but not all. 101 Mechanisms involved in vascular calcification in CKD include passive precipitation of Ca and P in the presence of excessively high extracellular concentrations, effects of inducers of osteogenic transformation and hydroxyapatite formation, and deficiency of calcification inhibitors.…”

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.…”

La calciphylaxie et ses manifestations stomatologiques

“…La parathyroïdectomie subtotale ou l'autotransplantation de tissu parathyroïdien sont très controversés 40,59 . En effet, devant l'urgence, Kang et al 37 estiment qu'il faut intervenir rapidement et de façon agressive si l'on souhaite obtenir une amélioration rapide de l'état général du patient.…”

“…Les corticostéroïdes ne sont pas utilisés car ils agissent comme challengers et précipitent la calciphylaxie 5,59 . Une approche multidisciplinaire et une collaboration entre le chirurgien, l'endocrinologue, le dermatologue et le néphrologue est capitale dans la prise en charge des patients atteints de calciphylaxie (Tab.…”