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Calciphylaxis in chronic, non-dialysis-dependent renal disease.

Pliquett RU, Schwock J, Paschke R, Achenbach H - BMC Nephrol (2003)

Bottom Line: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers.The role of renal disease in vascular complications is discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, University of Leipzig, Phillip-Rosenthal-Str, 27, Leipzig, Germany. rpliquett@endothel.de

ABSTRACT

Background: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.

Case report: A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers. She was hospitalized in an immobilized condition due to both the crural ulcerations and the existing heart-failure state (NYHA III-IV) having pleural and pericardial effusions, atrial fibrillation and weight loss of 30 kg over the past year. Despite normalization of calcium-phosphorus balance and improvement of renal function, the clinical course of crural ulcerations deteriorated during the following 3 months. After failure of surgical debridements, multiple courses of sterile-maggot therapy were introduced at a late stage to stabilize the wounds. The patient died of recurrent wound infections and sepsis paralleled by exacerbations of renal malfunction.

Conclusions: The role of renal disease in vascular complications is discussed. Sterile-maggot debridement may constitute a therapy for the ulcerated calciphylaxis at an earlier stage, i.e. when first ulcerations appear.

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Related in: MedlinePlus

Calciphylaxis cutis on admission. After transfer to the dermatologic department, about 1 month after first incidence of a calciphylactic ulcer of the lower right leg.
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Figure 1: Calciphylaxis cutis on admission. After transfer to the dermatologic department, about 1 month after first incidence of a calciphylactic ulcer of the lower right leg.

Mentions: A 53-year-old woman with a body mass index of 27.5 kg/m2 having chronic renal failure and chronic heart failure complained of painful crural, non-varicosis ulcers that started 8 months previously as livid palpable plaques or nodules within and underneath the skin, transforming into ulcers five weeks before admission and showing little sign of healing since. While a single, 2.5-cm ulcer closed, other ulcerations appeared at the right calf (Figure 1). Hence, the patient was admitted to a dermatologic department in an immobilized, weak condition having heart failure due to hypertensive and ischemic heart disease (left ventricular ejection fraction: 30 %, NYHA III-IV). Furthermore, she had a loss of appetite and lost 30 kg during the past year. Hypertension, recurrent ascendant urinary-tract infections and renal atherosclerosis were likely causes of renal failure. In addition, the patient had regularly taken analgesics. Systemic atherosclerosis was indicated by history of a myocardial infarction 5 years previously and by limitations of walking distance. In a coronary angiogram, a single-vessel coronary-artery disease was diagnosed necessitating an elective percutaneous coronary recanalization and stent deployment as well as three more percutaneous coronary interventions for repeated late in-stent restenosis during the previous 5 years. Clinical signs of the heart-failure state included both pleural and pericardial effusions, secondary mitral regurgitation due to cardiac dilation, and atrial fibrillation. The prevalent pericardial effusion was not deemed significant for cardiac filling as determined by echocardiography. Six months before admission, an Implantable Converter/Defibrillator (ICD) was inserted because of pre-syncope, non-sustained ventricular tachycardias in the Holter-ECG and a positive electrophysiological test result.


Calciphylaxis in chronic, non-dialysis-dependent renal disease.

Pliquett RU, Schwock J, Paschke R, Achenbach H - BMC Nephrol (2003)

Calciphylaxis cutis on admission. After transfer to the dermatologic department, about 1 month after first incidence of a calciphylactic ulcer of the lower right leg.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC222929&req=5

Figure 1: Calciphylaxis cutis on admission. After transfer to the dermatologic department, about 1 month after first incidence of a calciphylactic ulcer of the lower right leg.
Mentions: A 53-year-old woman with a body mass index of 27.5 kg/m2 having chronic renal failure and chronic heart failure complained of painful crural, non-varicosis ulcers that started 8 months previously as livid palpable plaques or nodules within and underneath the skin, transforming into ulcers five weeks before admission and showing little sign of healing since. While a single, 2.5-cm ulcer closed, other ulcerations appeared at the right calf (Figure 1). Hence, the patient was admitted to a dermatologic department in an immobilized, weak condition having heart failure due to hypertensive and ischemic heart disease (left ventricular ejection fraction: 30 %, NYHA III-IV). Furthermore, she had a loss of appetite and lost 30 kg during the past year. Hypertension, recurrent ascendant urinary-tract infections and renal atherosclerosis were likely causes of renal failure. In addition, the patient had regularly taken analgesics. Systemic atherosclerosis was indicated by history of a myocardial infarction 5 years previously and by limitations of walking distance. In a coronary angiogram, a single-vessel coronary-artery disease was diagnosed necessitating an elective percutaneous coronary recanalization and stent deployment as well as three more percutaneous coronary interventions for repeated late in-stent restenosis during the previous 5 years. Clinical signs of the heart-failure state included both pleural and pericardial effusions, secondary mitral regurgitation due to cardiac dilation, and atrial fibrillation. The prevalent pericardial effusion was not deemed significant for cardiac filling as determined by echocardiography. Six months before admission, an Implantable Converter/Defibrillator (ICD) was inserted because of pre-syncope, non-sustained ventricular tachycardias in the Holter-ECG and a positive electrophysiological test result.

Bottom Line: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers.The role of renal disease in vascular complications is discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, University of Leipzig, Phillip-Rosenthal-Str, 27, Leipzig, Germany. rpliquett@endothel.de

ABSTRACT

Background: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.

Case report: A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers. She was hospitalized in an immobilized condition due to both the crural ulcerations and the existing heart-failure state (NYHA III-IV) having pleural and pericardial effusions, atrial fibrillation and weight loss of 30 kg over the past year. Despite normalization of calcium-phosphorus balance and improvement of renal function, the clinical course of crural ulcerations deteriorated during the following 3 months. After failure of surgical debridements, multiple courses of sterile-maggot therapy were introduced at a late stage to stabilize the wounds. The patient died of recurrent wound infections and sepsis paralleled by exacerbations of renal malfunction.

Conclusions: The role of renal disease in vascular complications is discussed. Sterile-maggot debridement may constitute a therapy for the ulcerated calciphylaxis at an earlier stage, i.e. when first ulcerations appear.

Show MeSH
Related in: MedlinePlus