The Successful Treatment of Calciphylaxis with Sodium Thiosulfate and Hyperbaric Oxygen in a Non-dialyzed Patient with Chronic Kidney Disease

Abstract

We present the case of a non-dialyzed patient with chronic kidney disease and biopsy-proven calciphylaxis who presented with painful cutaneous ulcers on both legs. The skin ulcers drastically improved within 6 months after the initiation of hemodialysis, aggressive wound care, the control of a mineral and bone disorder, and the administration of sodium thiosulfate and hyperbaric oxygen therapy. Notably, the patient's serum levels of C-reactive protein and calciprotein particles decreased and her serum albumin and fetuin-A levels increased in parallel with the alleviation of her calciphylaxis. This case highlights the importance of applying combined medical treatment to calciphylaxis and suggests the possible involvement of calciprotein particles in the pathogenesis of calciphylaxis.

A 71-Year-Old Female with Myocardial Infarction and Long-Standing Ulcers on the Thigh

“…Wound care should be administered and adjusted according to the daily status of the ulcers. Management includes a combination of exudate control along with proper selection of wound dressing and chemical debridement agents [ 2 , 62 ]. Daily gentle enzymatic debridement of eschars [ 34 ] and atraumatic resection of necrotic skin [ 48 ] can facilitate wound healing.…”

The Histopathology of Leg Ulcers

“…However, there are also non-uremic causes such as hyperparathyroidism, malignancies or autoimmune diseases [70,71]. Its histopathological appearance is characterized by media calcification, endovascular fibrosis, intima hyperplasia and vascular thrombosis [72,73]. Additionally, ectopic calcium deposits can also be found in extravascular connective and adipose tissue [74] (see Table 5, Figure 4).…”

Calciphylaxis — pathogenesis and clinical picture

“…Good results can be achieved by utilizing sodium thiosulfate infusions at a dose of 25 g 3 times a week [23]. In case of patients who undergo dialysis, changing the dialysis programme, modifying the composition of the dialysis fluid and changing the method of dialysis (haemodialysis is preferred over peritoneal dialysis) should be considered [28][29][30][31].…”

“…Dobre efekty przynoszą wlewy tiosiarczanu sodowego (sodium thiosulfate) w dawce 25 g 3 razy w tygodniu [23]. W przypadku pacjentów dializowanych zmiana programu dializ oraz modyfikacja składu płynu dializacyjnego oraz rozważenie zmiany sposobu dializowania (preferowana hemodializa nad dializą otrzewnowa) [28][29][30][31].…”