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calciphylaxis and peritoneal dialysis

Yanchen Zhang, Kristin M Corapi, Maria Luongo, Ravi Thadhani, Sagar U Nigwekar
BACKGROUND: Calciphylaxis is a rare but devastating condition in end-stage renal disease (ESRD) patients. Most research in the field of calciphylaxis is focused on hemodialysis (HD) patients; however, data on calciphylaxis incidence, risk factors, and mortality in peritoneal dialysis (PD) patients are limited. METHODS: In this cohort study, we examined data from adult patients who initiated PD for ESRD management at our institute's PD unit from January 2001 to December 2015...
2016: International Journal of Nephrology and Renovascular Disease
Jee Eun Park, Seonggyu Byeon, Hee Kyung Kim, Seong Mi Moon, Ji Hoon Moon, Kee-Taek Jang, Byung-Jae Lee, Hye Ryoun Jang, Wooseong Huh, Dae Joong Kim, Yoon-Goo Kim, Ha Young Oh, Jung Eun Lee
Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation...
March 2016: Kidney Research and Clinical Practice
Edmond Sarkis
This is a rare case of penile and generalised calciphylaxis. We describe the case of a patient admitted to our hospital for septic shock and necrotic skin findings, end-stage renal disease on peritoneal dialysis. Skin findings turned out to be calciphyactic lesions. The patient was taken to the operating room for penile debridement and started on antibiotics. He was treated with sodium thiosulfate and switched to haemodialysis. Calciphylaxis is a rare disease in which the treatment is basically supportive. Further studies are needed to identify the risk factors, mechanisms of disease and treatment modalities...
2015: BMJ Case Reports
Ramón Alberto Tamayo-Isla, Mauro Cuba de la Cruz
INTRODUCTION: Calciphylaxis is a rare medical condition that is usually diagnosed in patients suffering from end-stage renal disease who are already receiving renal replacement therapy and in those post-transplantation. The pathogenesis still remains to be fully elucidated; hence, the treatment is not uniform. The prognosis is generally poor. The ulcerative stage exhibits a worse prognosis than the nonulcerative one. Calciphylaxis presenting in terminal kidney disease prior to dialytic treatment has only rarely been reported...
2015: International Journal of Nephrology and Renovascular Disease
Nakysa Hooman, Rama Naghshi-Zadiyan, Mitra Mehrazma, Fariba Jahangiri
Calciphylaxis is a complication of chronic kidney disease characterized by necrotic lesion in the skin. Histological examination reveals microcalcification of medium-sized blood vessels. We report on a 21-month-old girl with end-stage renal disease with severe calcium-phosphate imbalance. Calciphylaxis process started when she received calcium gluconate intravenously the day before the surgery to correct hypocalcemia and continued progressively despite peritoneal dialysis and forced stopping calcium-containing medication...
January 2015: Iranian Journal of Kidney Diseases
Konrad Buscher, Gert Gabriëls, Peter Barth, Hermann Pavenstädt
A 63-year-old woman presented with progredient bilateral breast pain. Her medical history included rheumatoid arthritis, AA amyloidosis and end-stage renal disease treated by peritoneal dialysis. Inflamed skin alterations of the breast and laboratory values suggested mastitis non-puerpuralis but antibiotics did not resolve the symptoms. Sonography and mammography showed severe vessel calcification suggesting calcific uraemic arteriolopathy (calciphylaxis) as a rare complication of chronic kidney disease. Treatment included intensified haemodialysis, thiosulfate application, analgaesia and wound management leading to significant improvement, however, without complete remission...
2015: BMJ Case Reports
Ana Pinho, Isabel Pinto, Sandra Sampaio, Pedro Neves
We describe the case of a 42-year-old woman who developed encapsulating peritoneal sclerosis (EPS) after 7 years on peritoneal dialysis, with clinical relief by enterolysis associated to treatment with tamoxifen, corticosteroids and parenteral nutrition in haemodialysis. During the next 7 months, she was also conservatively stabilised for mild hyperparathyroidism until she was admitted with calciphylaxis, associated with massive extraosseous calcification. Despite parathyroidectomy and sodium thiosulfate treatment, which resulted in a successful resolution of calciphylaxis, she died 1 year later due to a gross calcified peritoneum...
2014: BMJ Case Reports
Tina Wangen, Sandra Anderson, Kathryn Fencl, Sandi Mangan
Calciphylaxis is most common in patients with end-stage renal disease, and hyperparathyroidism is often present as well. But several cases in patients with normal renal and parathyroid function have been reported; this article describes one such case. The etiology and pathophysiology of calciphylaxis aren't well understood. There are many risk factors, and the reported median survival time is 2.6 months after diagnosis. The condition is characterized by isolated or multiple lesions that progress to firm, nonulcerated plaques and then to ischemic skin necrosis and ulceration...
October 2014: American Journal of Nursing
Lisa Borges, Pedro Rosa, Emanuel Dias, Isabel Cássio
A 48-year-old woman performing peritoneal dialysis for end-stage renal disease presented with a painful leg ulcer. The investigation revealed an elevated parathyroid hormone level and the histological examination of the biopsy tissue from the ulcer revealed medial calcification of the arterioles, consistent with calciphylaxis. The patient developed additional ulcers in the lower limbs and treatment with antibiotics, cinacalcet, sevelamer, sodium thiosulfate, low calcium dialysate and hyperbaric oxygen therapy was instituted...
2014: BMJ Case Reports
Kara Stavros, Rajeev Motiwala, Lan Zhou, Fatmir Sejdiu, Susan Shin
Calciphylaxis is a rare condition seen mostly in patients with chronic renal disease and secondary hyperparathyroidism who develop painful skin lesions and myopathy secondary to extensive small vessel calcification, which leads to tissue ischemia. It is typically diagnosed by a biopsy of prominent skin lesions. Here, we report a 49-year-old man with end-stage renal disease on chronic peritoneal dialysis who presented with weakness, myalgias, and necrotic skin lesions. Multiple skin biopsies were nondiagnostic because of severe extensive necrosis, and the diagnosis of systemic calciphylaxis was eventually made by a muscle biopsy...
March 2014: Journal of Clinical Neuromuscular Disease
Manzoor A Shah, Michael W Roppolo
Temporal artery calciphylaxis has rarely been described in chronic kidney disease patients on dialysis. We report a case of 72-year-old Caucasian man with multiple comorbidities and end-stage renal disease on dialysis who presented with temporal artery calcification leading to bilateral loss of vision followed by extensive skin lesions including one on glans penis. While on peritoneal dialysis, he developed anterior ischemic optic neuropathy, had no improvement on high dose steroids, and temporal artery biopsy showed marked calcification without any evidence of vasculitis...
2012: Case Reports in Nephrology
Trish Carter, Shobha Ratnam
Calciphylaxis is a rare and potentially devastating condition also referred to as uremic gangrene syndrome, calcific uremic arteriolopathy, metastatic calcification, and uremic small-vessel disease that can present in patients with end stage renal disease. This article reports a case of a 38-year-old African-American female on peritoneal dialysis for six years with a known history of non-adherence with diet, medications, and prescribed peritoneal dialysis treatment regimen. At her monthly clinic visit, the patient complained of burning sensation in the fingers of both hands with limited fine motor movement due to edema and severe pain...
September 2013: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Vincenzo Barbera, Luca Di Lullo, Antonio Gorini, Giovanni Otranto, Fulvio Floccari, Moreno Malaguti, Alberto Santoboni
Calciphylaxis, better described as "Calcific uremic arteriolopathy" (CUA), involves about 1-4% of hemodialysis patients all around the world with high mortality rates. We describe a rare clinical case of CUA in peritoneal dialysis patient associated with urological disease. Penile calciphylaxis represents rare clinical complication, and an early diagnosis and multidisciplinary approach are requested. Pathogenesis is still unclear, and therapeutic approaches need more long-term clinical trials to test their efficacy and safety...
2013: Case Reports in Urology
Katherine T Steele, Brendan J Sullivan, Karolyn A Wanat, Misha Rosenbach, Rosalie Elenitsas
Diffuse dermal angiomatosis (DDA) represents a benign, acquired, reactive proliferation of vessels. DDA is clinically characterized by painful livedoid plaques with central ulceration, and the histopathologic hallmark is diffuse endothelial cell hyperplasia in the dermis. DDA has been rarely reported in association with calciphylaxis, a condition characterized by calcification of arterial walls with accompanying thrombosis and cutaneous necrosis. We present a case of a 72-year-old man with end-stage renal disease on peritoneal dialysis who presented with painful lesions on his legs, and was found to have DDA in the setting of calciphylaxis...
September 2013: Journal of Cutaneous Pathology
Samrat Bhat, Shruti Hegde, Keith Bellovich, Mohamed El-Ghoroury
Calciphylaxis, a life-threatening and disabling complication in patients with end-stage renal disease, occurs most frequently in those treated with maintenance dialysis, whether it be hemodialysis or peritoneal dialysis. The impact of kidney transplantation on calciphylaxis lesions is not clear. The general consensus is to treat calciphylaxis adequately prior to transplantation with either medical therapy or parathyroidectomy, as indicated. We describe the case of a patient on peritoneal dialysis therapy who had severe calciphylaxis lesions that failed to resolve upon pretransplantation medical treatment and that then resolved after kidney transplantation...
July 2013: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
E Jorquera-Barquero, M C Súarez-Marrero, F Fernández Girón, J J Borrero Martín
Oxalosis is a disease caused by the deposition of calcium oxalate in extrarenal tissues, most commonly bone, myocardium, retina, blood vessels, and skin, causing the clinical manifestations of the disease. Involvement of the blood vessels of the skin can give rise to livedo reticularis, acrocyanosis, ulcers, and gangrene. We present the case of a 60-year-old woman with a history of recurrent renal lithiasis that had led to terminal renal failure requiring hemodialysis and, subsequently, peritoneal dialysis...
November 2013: Actas Dermo-sifiliográficas
Zorica Kauric-Klein
Caring for J.D. was a stressful experience. The extent of her wounds, pain, and limited options for treatment was very frustrating for the nursing staff. Although she did not survive, patient outcomes were met to some degree. Her pain was controlled to a greater extent, and there was less infection present in her wounds. The nurses worked with J.D. closely to improve her pain control and facilitate less painful dressing changes. They were vigilant in assessing the progress of her wound healing and communicating any increased signs of infections from her wounds...
September 2012: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Steven B Dethloff
Though CUA therapy with IP sodium thiosulfate represents an off-label usage of the drug, reports of its successful use are on the rise. It continues to be successfully administered both IP and IV, and in adult and pediatric populations. The long-term effects of IP sodium thiosulfate on the transport characteristics of the peritoneal membrane are not currently known, so they are an area for future research. Because the disease is so uncommon, small sample sizes limit the development of large, longitudinal studies...
July 2012: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Alina Markova, Jenna Lester, Joanne Wang, Leslie Robinson-Bostom
Cutaneous abnormalities in patients with end-stage renal disease (ESRD) receiving hemodialysis or peritoneal dialysis may demonstrate signs of their underlying condition or reveal associated disease entities. While a thorough examination of the scalp, skin, mucosa, and nails is integral to establishing a diagnosis, certain conditions will resolve only with dialysis or improvement of their renal disease and others may not require or respond to treatment. Half and half nails, pruritus, xerosis, and cutaneous hyperpigmentation are common manifestations in ESRD...
July 2012: Seminars in Dialysis
A Mallett, G T John, D Ranganathan, A Kark, I Berquier, J Casey, H Healy, L Francis
Calciphylaxis continues to present a clinical challenge for patient management. As in this case, it can be associated with connective tissue disease (CTD) such as systemic lupus erythematosus (SLE). Unlike previous reported cases, long-term remission has been attained. This provides some insight into methods of therapy as well as potential pathogenic models for this disease.
April 2012: Lupus
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