[Calcific arteriolopathy (Calciphylaxis)].
OBJECTIVE
Calcific arteriolopathy (CA), also known as " Calciphylaxis " describes a phenomenon of necrosis, mainly cutaneous and sometimes systemic, due to the obliteration of the arteriole's lumen. Initially there are under-intimal calcium deposits, and then the thrombosis occurs leading to the necrosis. CA affects mainly the renal insufficient hemodialysed patient, but not exclusively. We present 4 cases which illustrate well the etiologic spectrum of CA: terminal renal insufficiency, neoplasia, primary hyperparathyroidism, proteinuria, vitamin K inhibitors. We describe the AC's epidemiology, its cutaneous and systemic clinical presentations, its treatment. We make the hypothesis that CA is a strong risk marker in matter of cardiac mortality and we discuss this point.


BACKGROUND
In this article we describe the numerous breakthroughs that have been made in matter of research about calcification over the past few years: inhibitors of calcium phosphate deposition, vitamin D and PTH1R, protein-calcium complexes, cell death, induction of bone formation. These data are analysed from a clinical point of view with practical purposes. We present CA not only as a cutaneous disease but as a systemic pathology.


CONCLUSIONS
The CA epidemiology is an incentive to more diagnosis suspicion in front of organ infarct involving a patient likely to be concerned by CA. The scientific and therapeutic breakthroughs in matter of calcification enable a better prevention of the disease. Nevertheless it remains very difficult to cure when installed.
Duval
A
A
Clinique dermatologique, Hôpital Claude-Huriez, CHRU, 59037 Lille, France. arnaudduval@netcourrier.com
Moranne
O
O
Vanhille
P
P
Hachulla
E
E
Delaporte
E
E
D000368:Aged; D001160:Arterioles / Q000473:pathology; D001706:Biopsy; D002115:Calciphylaxis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D002118:Calcium / Q000097:blood; D003324:Coronary Artery Disease / Q000517:prevention & control; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D007871:Leg Ulcer / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010710:Phosphates / Q000097:blood; D011507:Proteinuria / Q000150:complications; D012867:Skin / Q000098:blood supply / Q000473:pathology; D014812:Vitamin K / Q000009:adverse effects / Q000037:antagonists & inhibitors
D010710:Phosphates; D014812:Vitamin K; D002118:Calcium