Skin wounds associated with calciphylaxis in end-stage renal disease patients on dialysis

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 26; no. 9; pp. 910 - 914
• Main Authors: DUSILOVA SULKOVA, Sylvie, VALEK, Martin
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2010; [New York]: Elsevier Science Inc; Elsevier; Elsevier Limited
• Subjects: Aged; animal injuries; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Calcific uremic arteriopathy; Calcio-phosphate metabolism; Calciphylaxis; Calciphylaxis - drug therapy; Calciphylaxis - etiology; Calciphylaxis - pathology; case studies; Chronic renal failure; Cinacalcet Hydrochloride; complications; Defects; Dialysis; Diphosphonates - therapeutic use; Disease; disease course; disease prevalence; end-stage renal disease; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Hemodialysis; Humans; Hyperparathyroidism, Secondary - etiology; Hyperparathyroidism, Secondary - pathology; Hyperparathyroidism, Secondary - surgery; Infections; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - pathology; Kidney Failure, Chronic - therapy; Metabolites; Middle Aged; Mortality; Naphthalenes - therapeutic use; necrosis; Parathyroidectomy; patients; Phosphates; prognosis; Renal Dialysis - adverse effects; sepsis (infection); skin; Skin - pathology; Skin Diseases - etiology; Skin Diseases - pathology; skin lesions; tissue repair; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin D; Calcific uremic arteriopathy; Dialysis; Calciphylaxis; Chronic renal failure; Calcio-phosphate metabolism; Kidney disease; Human; Phosphates; Urinary system disease; Cardiovascular disease; Metabolism; Wound; Vascular disease; Vertebrata; Mammalia; Skin
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2010.01.018

Calciphylaxis is a rare complication of chronic renal failure mostly with poor prognosis. Painful lesions on various skin surface areas are the most prominent feature of this serious disease. Subsequent infection of necrotic skin tissue is associated with the risk of sepsis. Pathophysiology is unclear, but several risk factors are known. The most important risk factor is impaired calcium-phosphate metabolism. Our paper describes two cases of different forms of calciphylaxis in patients with chronic renal failure. In the first case, pamidronate and cinacalcet were used for treatment. In the second described case, calciphylaxis was associated with secondary hyperparathyroidism and immediate subtotal parathyroidectomy was performed. Both patients were successfully treated, using systemic approach as well as dedicated local care for healing of skin wounds.