Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/8566
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Type: Journal article
Title: Cutaneous necrosis from calcific uremic arteriolopathy
Author: Coates, T.
Kirkland, G.
Dymock, R.
Murphy, B.
Brealey, J.
Mathew, T.
Disney, A.
Citation: American Journal of Kidney Diseases, 1998; 32(3):384-391
Publisher: W.B. Saunders
Issue Date: 1998
ISSN: 0272-6386
1523-6838
Abstract: Calcific uremic arteriolopathy (calciphylaxis) is an uncommon complication of chronic renal failure that is associated with high morbidity and mortality. We report 16 patients (13 female) who presented between 1985 and 1996. All patients developed painful livido reticularis that progressed to cutaneous necrosis and ulceration (11 cases on the proximal extremities and five cases on the distal extremities). Two patients with predominately distal leg disease survived; the cause of death in the other 14 patients was sepsis (six patients), withdrawal from dialysis (three), cardiac arrest (three), and gastrointestinal hemorrhage (two). Mesenteric ischemia from intestinal vascular calcification occurred in two cases. Clinical factors identified included the use of warfarin therapy in seven cases and significant weight loss (>10% body weight) in seven cases in the 6 months preceding the development of calcific uremic arteriolopathy. Skin pathology was studied in 12 cases, with all showing calcific panniculitis and small vessel calcification. Electron microscopic spectral analysis of the mineral content of the calcific lesions in the subcutaneous tissue showed only calcium and phosphorous. In two cases, substitution of low molecular weight heparin for warfarin therapy resulted in clinical improvement. Current theories of pathogenesis and treatment are reviewed. This study confirms the high morbidity and mortality of calcific uremic arteriolopathy producing ischemic tissue necrosis while drawing attention to significant weight loss and warfarin therapy as risk factors for the development of ischemic tissue necrosis. Hyperbaric oxygen therapy warrants further study.
Keywords: Arterioles
Skin
Humans
Kidney Failure, Chronic
Uremia
Calciphylaxis
Necrosis
Phosphates
Calcium
Parathyroid Hormone
Biopsy
Parathyroidectomy
Cause of Death
Survival Rate
Adult
Aged
Middle Aged
Female
Male
DOI: 10.1053/ajkd.1998.v32.pm9740153
Published version: http://dx.doi.org/10.1053/ajkd.1998.v32.pm9740153
Appears in Collections:Aurora harvest 4
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