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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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Calciphylaxis cutis, 2 months after admission. Large ulcerations at both lower legs with signs of superinfection.
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Figure 2: Calciphylaxis cutis, 2 months after admission. Large ulcerations at both lower legs with signs of superinfection.

Mentions: Despite wound care on a daily basis both in hospital and in ambulatory care, the cutaneous ulcers worsened. 2 months after first admission, the patient was readmitted because of exacerbated ulcers on both lower legs (Figure 2). Hydrocolloid dressings failed because of the size and number of wounds. Instead, an active-charcoal absorband dressing combined with repeated surgical necrectomy was applied to stabilize the wound situation in conjunction with antibiotic therapy guided by wound-secretion-derived microbiological cultures. Parathyroid function remained normal. Following a 1-month consolidation therapy the patient was discharged with a stable wound condition to continue wound care at home. However, the large extent of those ulcers affecting both lower legs remained unchanged at the time of discharge compared to admission.


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

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

Calciphylaxis cutis, 2 months after admission. Large ulcerations at both lower legs with signs of superinfection.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Calciphylaxis cutis, 2 months after admission. Large ulcerations at both lower legs with signs of superinfection.
Mentions: Despite wound care on a daily basis both in hospital and in ambulatory care, the cutaneous ulcers worsened. 2 months after first admission, the patient was readmitted because of exacerbated ulcers on both lower legs (Figure 2). Hydrocolloid dressings failed because of the size and number of wounds. Instead, an active-charcoal absorband dressing combined with repeated surgical necrectomy was applied to stabilize the wound situation in conjunction with antibiotic therapy guided by wound-secretion-derived microbiological cultures. Parathyroid function remained normal. Following a 1-month consolidation therapy the patient was discharged with a stable wound condition to continue wound care at home. However, the large extent of those ulcers affecting both lower legs remained unchanged at the time of discharge compared to admission.

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