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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 Medicine publications |
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