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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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Calcifications of the left atrial wall of the heart. Autopsy revealed calcifications and endocardial fibrosis within the wall of the left atrium.
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Figure 6: Calcifications of the left atrial wall of the heart. Autopsy revealed calcifications and endocardial fibrosis within the wall of the left atrium.

Mentions: The diagnosis of Calciphylaxis cutis was confirmed by autopsy, revealing small- and medium-sized blood-vessel calcifications within the ulcerated skin of the lower legs as previously seen in the biopsy (Figure 4 and 5). Even capillaries were found to be surrounded by calcific deposits. The patient was shown to have severe calcified atherosclerotic lesions occasionally involving the whole circumference of the aorta and the coronary arteries with an in-stent restenosis within the right coronary artery. Furthermore, the patient presented intermediate-grade atherosclerosis in renal as well as in lower-leg peripheral arteries. Unusual locations of calcifications were the wall of the left atrium of the heart (Figure 6) and pulmonary arteries.


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

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

Calcifications of the left atrial wall of the heart. Autopsy revealed calcifications and endocardial fibrosis within the wall of the left atrium.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 6: Calcifications of the left atrial wall of the heart. Autopsy revealed calcifications and endocardial fibrosis within the wall of the left atrium.
Mentions: The diagnosis of Calciphylaxis cutis was confirmed by autopsy, revealing small- and medium-sized blood-vessel calcifications within the ulcerated skin of the lower legs as previously seen in the biopsy (Figure 4 and 5). Even capillaries were found to be surrounded by calcific deposits. The patient was shown to have severe calcified atherosclerotic lesions occasionally involving the whole circumference of the aorta and the coronary arteries with an in-stent restenosis within the right coronary artery. Furthermore, the patient presented intermediate-grade atherosclerosis in renal as well as in lower-leg peripheral arteries. Unusual locations of calcifications were the wall of the left atrium of the heart (Figure 6) and pulmonary arteries.

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