Fatal calcific uraemic arteriolopathy (CUA): A case report and review of the literature

Scottish Medical Journal

Volumn 49, Issue 3, 2004, Pages 108-111

  Lang, Ninian ^a   Davie, R ^c   Whitworth, C ^b   Winney, R ^b   Hughes, J ^b  

^a QUEEN MARGARET HOSPITAL   (United Kingdom)

^b ROYAL INFIRMARY OF EDINBURGH   (United Kingdom)

^c ST JOHN'S HOSPITAL   (United Kingdom)

Author keywords

Calcific uraemic arteriolopathy; Calciphylaxis; Renal failure; Ulceration

Indexed keywords

ALFACALCIDOL; AMOXICILLIN PLUS CLAVULANIC ACID; ANTIBIOTIC AGENT; BUMETANIDE; CYCLOSPORIN A; DOXAZOSIN; ERYTHROPOIETIN; FERROUS GLUCONATE; FLUCLOXACILLIN; GABAPENTIN; METICILLIN; METOPROLOL; METRONIDAZOLE; MYCOPHENOLIC ACID 2 MORPHOLINOETHYL ESTER; OMEPRAZOLE; PENICILLIN V; PHOSPHATE BINDING AGENT; PRAVASTATIN; PREDNISOLONE; RAMIPRIL; TEICOPLANIN; WARFARIN;

ADULT; ANGIOGRAPHY; ARTERIOLE; ARTICLE; BLOOD TRANSFUSION; BLOOD VESSEL CALCIFICATION; BLOOD VESSEL OCCLUSION; CALCINOSIS; CASE REPORT; CLINICAL FEATURE; CONTINUOUS AMBULATORY PERITONEAL DIALYSIS; DEATH; DEBRIDEMENT; DECUBITUS; DIET THERAPY; DISEASE SEVERITY; DRUG WITHDRAWAL; FEMALE; GANGRENE; HISTOPATHOLOGY; HUMAN; HUMAN TISSUE; KIDNEY FAILURE; KIDNEY TRANSPLANTATION; LEG EDEMA; LEG ULCER; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; PAIN; SECONDARY HYPERPARATHYROIDISM; SKIN DEFECT; SKIN ULCER; SYNDROME; TREATMENT PLANNING; WOUND HEALING IMPAIRMENT;

EID: 4544366890     PISSN: 00369330     EISSN: None     Source Type: Journal    
DOI: 10.1177/003693300404900313     Document Type: Article

References (25)

1. Angelis, M, L.L. Wong, S.A. Myers, and L.M. Wong. Calciphylaxis in patients on hemodialysis: a prevalence study. Surgery. 1997; 122, no. 6:1083-9.
2. Fine, A., and J. Zacharias. Calciphylaxis is usually non-ulcerating: risk factors, outcome and therapy. 2002; 61 6, no. 2210-7.
3. Zacharias, J.M., B. Fontaine, and A. Fine. Calcium use increases risk of calciphylaxis: a case-control study. Perit Dial Int. 1999; 19, no. 3:248-52.
4. Mathur, R.V., J.R. Shortland, and A.M. el-Nahas. Calciphylaxis. Postgrad Med J. 2001; 77, no. 911:557-61.
5. Lim, S.P., K. Batta, and B.B. Tan. Calciphylaxis in a patient with alcoholic liver disease in the absence of renal failure. Clin Exp Dermatol. 2003; 28, no. 1:34-6.
6. Goyal, S., K.M. Huhn, and T.T. Provost. Calciphylaxis in a patient without renal failure or elevated parathyroid hormone: possible aetiological role of chemotherapy. Br J Dermatol. 2000; 143, no. 5:1087-90.
7. Wilmer, W.A., and C.M. Magro. Calciphylaxis: emerging concepts in prevention, diagnosis, and treatment. Semin Dial. 2002; 15, no. 3:172-86.
8. Ahmed, S., K.D. O'Neill, A.F. Hood, et al. Calciphylaxis is associated with hyperphosphatemia and increased osteopontin expression by vascular smooth muscle cells. Am J Kidney Dis. 2001; 37, no. 6:1267-76.
9. Canfield, A.E., C. Farrington, M.D. Dziobon, et al. The involvement of matrix glycoproteins in vascular calcification and fibrosis: an immunohistochemical study. J Pathol. 2002; 196, no. 2:228-34.
10. Schafer, C., A. Heiss, A. Schwarz, et al. The serum protein alpha 2-Heremans-Schmid glycoprotein/fetuin-A is a systemically acting inhibitor of ectopic calcification. J Clin Invest. 2003; 112, no. 3:357-66.
11. Wesson, J.A., R.J. Johnson, J. Hughes et al. Osteopontin is a critical inhibitor of calcium oxalate crystal formation and retention in renal tubules. J Am Soc Nephrol. 2003; 14, no. 1:139-47.
12. Speer, M.Y., M.D. McKee, R.E. Guldberg, et al. Inactivation of the osteopontin gene enhances vascular calcification of matrix Gla protein-deficient mice: evidence for osteopontin as an inducible inhibitor of vascular calcification in vivo. J Exp Med. 2002; 196, no. 8:1047-55.
13. Ketteler, M., C. Wanner, T. Metzger, et al. Deficiencies of calcium-regulatory proteins in dialysis patients: a novel concept of cardiovascular calcification in uremia. Kidney Int Suppl. 2003; 84:S84-7.
14. Zimmermann, J., S. Herrlinger, A. Pruy, T. Metzger, and C. Wanner. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int. 1999; 55, no. 2:648-58.
15. Lebreton, J.P., F. Joisel, J.P. Raoult, B. Lannuzel, J.P. Rogez, and G. Humbert. Serum concentration of human alpha 2 HS glycoprotein during the inflammatory process: evidence that alpha 2 HS glycoprotein is a negative acute-phase reactant. J Clin Invest. 1979; 64, no. 4:1118-29.
16. Ketteler, M., C. Vermeer, C. Wanner, R. Westenfeld, W. Jahnen-Dechent, and J. Floege. Novel insights into uremic vascular calcification: role of matrix Gla protein and alpha-2-Heremans Schmid glycoprotein/fetuin. Blood Purif. 2002; 20, no. 5:473-6.
17. Bahar, G., D. Mimouni, M. Feinmesser, M. David, A. Popovzer, and R. Feinmesser. Subtotal parathyroidectomy: a possible treatment for calciphylaxis. Ear Nose Throat J. 2003; 82, no. 5:390-3.
18. Younis, N., R.A. Sells, A. Desmond, et al. Painful cutaneous lesions, renal failure and urgent parathyroidectomy. J Nephrol. 2002; 15, no. 3:324-9.
19. Kang, A.S., J.T. McCarthy, C. Rowland, D.R. Farley, and J.A. van Heerden. Is calciphylaxis best treated surgically or medically? Surgery. 2000; 128, no. 6:967-71.
20. Russell, R., M.A. Brookshire, M. Zekonis, and S.M. Moe. Distal calcific uremic arteriolopathy in a hemodialysis patient responds to lowering of Ca × P product and aggressive wound care. Clin Nephrol. 2002; 58, no. 3:238-43.
21. Tittelbach, J., T. Graefe, and U. Wollina. Painful ulcers in calciphylaxis - combined treatment with maggot therapy and oral pentoxyfillin. J Dermatolog Treat. 2001; 12, no. 4:211-4.
22. Milas, M., R.L. Bush, P. Lin, K., et al. Calciphylaxis and nonhealing wounds: the role of the vascular surgeon in a multidisciplinary treatment. J Vasc Surg. 2003; 37, no. 3:501-7.
23. Don, B.R., and A.I. Chin. A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies. Clin Nephrol. 2003; 59, no. 6:463-70.
24. Wilmer, W.A., O. Voroshilova, I. Singh, D.F. Middendorf, and F.G. Cosio. Transcutaneous oxygen tension in patients with calciphylaxis. Am J Kidney Dis. 2001; 37, no. 4:797-806.
25. Basile, C., A. Montanaro, M. Masi, G. Pati, P. De Maio, and A. Gismondi. Hyperbaric oxygen therapy for calcific uremic arteriolopathy: a case series. J Nephrol. 2002; 15., no. 6:676-80.