Rapidly progressive severe vascular calcification sparing the kidney allograft following warfarin initiation.
We describe a case of rapid onset of vascular calcification coincident with the initiation of warfarin therapy in a kidney transplant recipient. Calcification developed within the media of the blood vessel wall, with relative intimal sparing. Medium and small arteries were affected; however, the aorta was mostly free of calcifications, suggesting a differential response to warfarin between the intima and media and between different vascular beds. In addition, unlike the highly calcified native kidney's vessels, the kidney allograft was not calcified, suggesting local genetically determined mechanisms in preventing vascular calcification. Distal subcutaneous necrosis ultimately led to the patient's death.
Hristova
Marta
M
Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. mhristov@bidmc.harvard.edu
van Beek
Christine
C
Schurgers
Leon J
LJ
Lanske
Beate
B
Danziger
John
J
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D002114:Calcinosis / Q000139:chemically induced* / Q000175:diagnosis; D017809:Fatal Outcome; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D014652:Vascular Diseases / Q000139:chemically induced* / Q000175:diagnosis; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin
J Am Soc Nephrol. 2009 Oct;20(10):2223-33
19713308
J Am Acad Dermatol. 2009 Aug;61(2):325-32
19615543
Arterioscler Thromb Vasc Biol. 2005 Aug;25(8):1629-33
15961706
Blood. 2004 Nov 15;104(10):3231-2
15265793
Am J Kidney Dis. 1998 Sep;32(3):384-91
9740153
Arterioscler Thromb Vasc Biol. 2000 Nov;20(11):2386-93
11073842
Am J Cardiol. 2005 Sep 15;96(6):747-9
16169351
J Cell Biol. 2004 Jun 7;165(5):625-30
15184399
Arterioscler Thromb Vasc Biol. 1998 Sep;18(9):1400-7
9743228
Clin J Am Soc Nephrol. 2008 Sep;3(5):1504-10
18495950
Kobe J Med Sci. 2004;50(3-4):69-81
15864013
J Nephrol. 2007 Jul-Aug;20(4):417-22
17879207