- Calcific uremic arteriolopathy - Vascular calcification, thrombosis, and skin necrosis
- Rare but serious, seen mainly in ESRF pts
- Commonly who are on HD or who have recently received a kidney transplant
- Not exclusive to patients with ESRD (Non-uraemic calciphylaxis)
- Seen in 1°HPT, breast cancer (treated with chemo), EtOH liver cirrhosis, cholangioca, Crohn’s, RA, and SLE
- Chronic non-healing wounds and can be fatal
- Clinical diagnosis
- Characteristic ischaemic skin lesions with areas of skin necrosis associated with severe pain
- Appears as violaceous, leathery lesions and can be extensive
- Confirm with skin biopsy
- Small arterial calcification and occlusion in the absence of vasculitis
- Bone scintigraphy may show increased tracer accumulation in the soft tissues
- Treatment
- Results for calciphylaxis are variable, prevention is crucial
- Rigorous and continuous control of phosphate and calcium balance
- Necrotic skin areas may become infected, leading to sepsis
- Overall, clinical prognosis poor
- Urgent Subtotal Parathyroidectomy is usually recommended