title: [Calcific uremic arteriolopathy (Calcyphilaxis): a rare disease? Report of three cases].
abstract: BACKGROUND
  Calcific uremic arteriolopathy (CUA; CALCYPHILAXIS) is a syndrome that occurs prevalently in patients with chronic kidney disease on dialysis. It is characterized by the medial calcification of skin small arteries leading to necrotic lesions. Several risk factors have been identified: obesity, female gender, diabetes mellitus, hyperphosphatemia, inflammation, treatment with vitamin D, calcium-based phosphate binders and warfarin.
  
  
  METHODS
  We report three cases of CUA observed from October 2011 to September 2014.
  
  
  RESULTS
  The mean age at diagnosis was 56 years (range 33-68). Biochemistry showed: mean levels of PTH=1277 pg/ml (range 1000-1696), serum calcium =10.2 mg/dl (range 9.4-11.1), phosphorus=4.5 mg/dl (range 3.4-5.5). All patients were taking vitamin D, two patients were on warfarin therapy. Following actions were undertaken: interruption of calcium-based phosphate binders, vitamin D and warfarin therapy, initiation of cinacalcet and sodium thiosulfate therapy, use of dialysate with lowest available calcium concentration (1.25 mmol/l), Hyperbaric Oxygen Therapy, surgical dressings of skin lesions three times a week. Significant improvement was observed in mean levels of PTH (331 pg/ml, range 200-465), serum calcium (8.3 mg/dl, range 7.4-9.6) and phosphorus (3.4 mg/dl, range 2.6-3.8). In two out of three patients complete healing of ulcerative lesions was obtained.
  
  
  CONCLUSIONS
  These cases underline the importance of early diagnosis of CUA especially in patients with concomitant risk factors and careful clinical monitoring, being CUA characterized by a rapid evolution and high mortality.
authors.forename: Paola
authors.initials: P
authors.lastname: Napolitano
authors.forename: Alfredo
authors.initials: A
authors.lastname: Capuano
authors.forename: Ludovica
authors.initials: L
authors.lastname: D'Apice
authors.forename: Francesca
authors.initials: F
authors.lastname: Mosella
authors.forename: Andrea
authors.initials: A
authors.lastname: Pota
authors.forename: Caterina
authors.initials: C
authors.lastname: Saviano
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
mesh_terms: D000328:Adult; D000368:Aged; D002115:Calciphylaxis / Q000209:etiology* / Q000628:therapy; D002614:Chelating Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D035583:Rare Diseases / Q000209:etiology*; D006435:Renal Dialysis / Q000009:adverse effects*; D017445:Skin Diseases, Vascular / Q000209:etiology* / Q000628:therapy; D013577:Syndrome; D014807:Vitamin D / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage; D028761:Withholding Treatment
chemical_list: D002614:Chelating Agents; D014815:Vitamins; D014807:Vitamin D