title: Rapidly progressive severe vascular calcification sparing the kidney allograft following warfarin initiation.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. mhristov@bidmc.harvard.edu
authors.forename: Marta
authors.initials: M
authors.lastname: Hristova
authors.forename: Christine
authors.initials: C
authors.lastname: van Beek
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Schurgers
authors.forename: Beate
authors.initials: B
authors.lastname: Lanske
authors.forename: John
authors.initials: J
authors.lastname: Danziger
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D014859:Warfarin
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