Maximal conservative therapy of calcific uremic ateriolopathy.
We present the case of a 61-year- old female patient in long-term hemodialysis who developed calcific uremic arteriolopathy (CUA) upon administration of the oral calcimimetic agent cinacalcet for treatment of secondary hyperparathyroidism. In May 2009, the baseline serum values were parathormone (PTH) 310 pg/ml, calcium 9.1 mg/dl and phosphorous 6.9 mg/dl. Necrotic wounds in the suprapubic fat tissue were successfully treated first, by correcting the calcium phosphorous product; second, through treatment with sodium thiosulfate and third, through intensive wound care with hyperbaric oxygen therapy and vacuum-assisted closure therapy, with no need for parathyroidectomy. Multiple factors have been described to play a role in the development of CUA. Based on the findings of this case, the treatment of CUA should be aimed at correcting different causes simultaneously.
Department of Nephrology-Hypertension, Antwerp University Hospital, Belgium.
Charlotte
C
Van Noten
Karin
K
Janssen van Doorn
Evert
E
Vermander
Sonja
S
Vlayen
Gert A
GA
Verpooten
Marie-Madeleine
MM
Couttenye
D001160:Arterioles / Q000187:drug effects / Q000473:pathology; D057966:Calcimimetic Agents / Q000009:adverse effects*; D002614:Chelating Agents / Q000627:therapeutic use*; D000069449:Cinacalcet; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009281:Naphthalenes / Q000009:adverse effects*; D054843:Negative-Pressure Wound Therapy; D006435:Renal Dialysis; D013885:Thiosulfates / Q000627:therapeutic use*; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications* / Q000209:etiology / Q000628:therapy*; D061205:Vascular Calcification / Q000139:chemically induced / Q000473:pathology / Q000628:therapy*
D057966:Calcimimetic Agents; D002614:Chelating Agents; D009281:Naphthalenes; D013885:Thiosulfates; C017717:sodium thiosulfate; D000069449:Cinacalcet