title: Calciphylaxis in dialysis patients, a severe disease poorly responding to therapies: report of 4 cases.
abstract: Calciphylaxis or calciphic uremic arteriolopathy (CUA) is a rare syndrome characterized by the deposition of calcium within the walls of small and medium size vessels in the dermis and in the subcutaneous tissue. The disease mainly affects patients with end-stage renal disease. We report here our experience with 4 cases of calciphylaxis in dialysis patients. The main predisposing factor observed in our 4 patients was warfarin use (2 patients, 50%), while local traumas and diabetes were respectively present in only one patient. None of our patients was obese. Lower legs were the most frequently involved site of CUA (3/4 patients, 75%). In our experience biopsy was crucial to achieve a correct diagnosis and did not cause aggravation of the ulcers. Therapeutic approach was multimodal: mainly hyperbaric oxygen therapy, cinacalcet and sodium thiosulphate. Although many recent case reports have shown exceptional results and healing with the use of sodium thiosulphate, we did not experience any change in the poor prognosis of our patients with the use of this drug, at a dosage of 5 g thrice weekly endovenously.
authors.affiliation: Unit of Dermatology, AUSL Ravenna, Ravenna, Italy - francescosavoia76@virgilio.it.
authors.forename: F
authors.initials: F
authors.lastname: Savoia
authors.forename: G
authors.initials: G
authors.lastname: Gaddoni
authors.forename: A
authors.initials: A
authors.lastname: Patrizi
authors.forename: C
authors.initials: C
authors.lastname: Misciali
authors.forename: G
authors.initials: G
authors.lastname: Odorici
authors.forename: G
authors.initials: G
authors.lastname: Tampieri
authors.forename: E
authors.initials: E
authors.lastname: Tampieri
authors.forename: S
authors.initials: S
authors.lastname: Cantelli
authors.forename: M
authors.initials: M
authors.lastname: Aldi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D002115:Calciphylaxis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D000069449:Cinacalcet; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000737:chemistry; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D006931:Hyperbaric Oxygenation; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007871:Leg Ulcer / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012883:Skin Ulcer / Q000209:etiology; D013885:Thiosulfates / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D015312:Hemodialysis Solutions; D009281:Naphthalenes; D013885:Thiosulfates; C006871:calcium heparin; D014859:Warfarin; D006493:Heparin; C017717:sodium thiosulfate; D000069449:Cinacalcet