title: Calciphylaxis and subtotal parathyroidectomy: a double-edged sword.
abstract: Calciphylaxis, also called calcific uremic arteriolopathy is a dreadful, life-threatening ischemic vasculopathy, primarily involving skin and subcutaneous tissue, mostly on patients with end-stage kidney disease. Calciphylaxis is a well-described, but still a poorly understood disorder of mineral metabolism. Its occurrence is rare, but increasingly reported. We describe a 62-year-old obese lady on hemodialysis for end-stage kidney disease due to type 2 diabetes, who developed two episodes of calciphylactic skin lesions during the 3 years observation. The healing of lesions in the first episode was prompted by a subtotal parathyroidectomy for severe secondary hyperparathyroidism. However, the resumption of oral calcium and vitamin D analog for the parathyroidectomy-related hypocalcemia induced another occurrence of widespread calciphylactic skin lesions in areas of great adiposity. The typical regimen of IV sodium thiosulfate brought a successful outcome to the second episode. Now, growing numbers of successful treatment for calciphylaxis are reported with more specific therapies and a clear understanding of the pathogenetic mechanism is in sight.
authors.affiliation: Nephrology Division, Montefiore Medical Center - Wakefield Campus, Bronx, New York, USA.
authors.forename: Madhavi
authors.initials: M
authors.lastname: Katikaneni
authors.forename: Lin
authors.initials: L
authors.lastname: Lwin
authors.forename: Hugo
authors.initials: H
authors.lastname: Villanueva
authors.forename: Jinil
authors.initials: J
authors.lastname: Yoo
mesh_terms: D002115:Calciphylaxis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*; D006435:Renal Dialysis; D012871:Skin Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*
keywords: Calciphylaxis; end stage kidney disease; hemodialysis; hypocalcemia; parathyroidectomy; sodium thiosulfate