Cutaneous necrosis by calcific uremic arteriolopathy.
BACKGROUND
Calcific uremic arteriolopathy is a rare and serious disorder characterized by systemic medial calcification of the arteries and tissue ischemia. Most often it is found in patients with chronic renal failure on dialysis and in renal transplant recipients with secondary hyperparathyroidism.


METHODS
We report six patients with end-stage renal disease [five on hemodialysis (one with a nonfunctioning renal graft) and one on peritoneal dialysis] who developed painful livedo reticularis and skin necrosis of the limbs. All had secondary hyperparathyroidism and elevated calcium-phosphorus product. Our patients presented with the following clinical features: white race (six patients), hypoalbuminemia (three patients), diabetes (one patient), and obesity (four patients).


RESULTS
Subtotal parathyroidectomy was performed in three cases. Despite this procedure, two patients died; one patient survived and his lesions healed. One patient was treated with aggressive wound care and hemodialysis (with low dialysate calcium concentration and Renagel phosphorus binders) and one patient received only local wound care, both with improvement of their lesions. In one case, no therapy was performed because the patient died immediately after diagnosis.


CONCLUSIONS
The three patients who survived (Cases 4, 5 and 6) had distal lesions, normal serum albumin, and an early diagnosis. There was a relationship between the outcome of the patients and these factors, rather than the type of treatment received.
Galimberti
Ricardo Luis
RL
Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ricardo.galimberti@hospitalitaliano.org.ar
Farias
Eduardo Dos Ramos
Edos R
Parra
Isabel Hidalgo
IH
Algranati
Luis
L
Kowalczuk
Alicia
A
Imperiali
Nora
N
Greloni
Gustavo Cristian
GC
Galimberti
Gastón
G
D000328:Adult; D000368:Aged; D002115:Calciphylaxis / Q000150:complications / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000473:pathology; D006435:Renal Dialysis; D012867:Skin / Q000473:pathology*; D017445:Skin Diseases, Vascular / Q000209:etiology / Q000473:pathology*