Calciphylaxis in pediatric end-stage renal disease.
Calciphylaxis is a rare, but life-threatening complication of end-stage renal disease (ESRD) that has been reported mostly in adult patients. The exact etiology is unknown, but the disease is commonly associated with a high calcium-phosphorus product and elevated levels of parathyroid hormone (PTH). We herein review the published reports on calciphylaxis in ESRD patients less than 18 years old and report the case of a patient with severe calciphylaxis who presented with lower extremity pain, muscle tenderness and difficulty in walking. The serum PTH was low, and the calcium-phosphorus product was normal. The diagnosis of calciphylaxis was confirmed by a muscle biopsy. Treatment with low calcium peritoneal dialysate and substitution of calcium-based phosphorus binders with sevelamer (Renagel) was unsuccessful. The patient's clinical condition progressed to extensive soft tissue calcification and ulcerating skin lesions. Nine months after the onset of symptoms, the patient died of cardiopulmonary arrest.
Imam
Abubakr A
AA
Division of Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA. aimam@med.wayne.edu
Mattoo
Tej K
TK
Kapur
Gaurav
G
Bloom
David A
DA
Valentini
Rudolph P
RP
D000293:Adolescent; D001706:Biopsy; D002115:Calciphylaxis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D002118:Calcium / Q000097:blood; D017809:Fatal Outcome; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D010146:Pain / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000031:analogs & derivatives / Q000097:blood; D010530:Peritoneal Dialysis; D010758:Phosphorus / Q000097:blood; D012867:Skin / Q000473:pathology
C470125:PTH protein, human; D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium