Calciphylaxis and subtotal parathyroidectomy: a double-edged sword.

Abstract

Calciphylaxis, also called calcific uremic arteriolopathy is a dreadful, life-threatening ischemic vasculopathy, primarily involving skin and subcutaneous tissue, mostly on patients with end-stage kidney disease. Calciphylaxis is a well-described, but still a poorly understood disorder of mineral metabolism. Its occurrence is rare, but increasingly reported. We describe a 62-year-old obese lady on hemodialysis for end-stage kidney disease due to type 2 diabetes, who developed two episodes of calciphylactic skin lesions during the 3 years observation. The healing of lesions in the first episode was prompted by a subtotal parathyroidectomy for severe secondary hyperparathyroidism. However, the resumption of oral calcium and vitamin D analog for the parathyroidectomy-related hypocalcemia induced another occurrence of widespread calciphylactic skin lesions in areas of great adiposity. The typical regimen of IV sodium thiosulfate brought a successful outcome to the second episode. Now, growing numbers of successful treatment for calciphylaxis are reported with more specific therapies and a clear understanding of the pathogenetic mechanism is in sight.

• Authors: Madhavi Katikaneni, Lin Lwin, Hugo Villanueva, Jinil Yoo
• Journal: Hemodialysis international. International Symposium on Home Hemodialysis (Hemodial Int) Vol. 17 Suppl 1 Pg. S33-6 (Oct 2013) ISSN: 1542-4758 [Electronic] Canada
• PMID: 24134329 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2013 The Authors. Hemodialysis International © 2013 International Society for Hemodialysis.

Topics

• Calciphylaxis (complications, pathology, surgery)
• Female
• Humans
• Hyperparathyroidism (complications, surgery)
• Kidney Failure, Chronic (complications, therapy)
• Middle Aged
• Parathyroidectomy (methods)
• Renal Dialysis
• Skin Diseases (complications, pathology, surgery)