title: Multidisciplinary approach to calcific uremic arteriolopathy.
abstract: OBJECTIVE
  Calcific uremic arteriolopathy (CUA), as known as calciphylaxis, is a rare and poorly understood disease seen predominantly in end stage renal disease patients. A collaborative multidisciplinary approach to develop and implement treatment and prevention methods is described.
  
  
  RESULTS
  Overall, the scientific literature on CUA is largely restricted to case reports and case series. Recent reports indicate that the incidence of CUA may be on the rise and emphasize an association with vitamin K antagonist therapy, obesity, and diabetes mellitus. Serum calcium, phosphorous, and parathyroid hormone levels have been reported to be quite variable in patients with CUA and may reflect the heterogeneity of study designs. A multidisciplinary and multimodal approach that incorporates wound and pain management, sodium thiosulfate, optimization of mineral bone parameters, bisphosphonates, and avoidance of risk factors such as vitamin K antagonist has been advocated in the latest reports. Sodium thiosulfate although used frequently to treat CUA has unclear efficacy requiring further examination.
  
  
  CONCLUSIONS
  This review describes the recent literature in the field of CUA including its limitations. It provides a summary of a multidisciplinary approach to CUA management.
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Sagar U
authors.initials: SU
authors.lastname: Nigwekar
mesh_terms: D002115:Calciphylaxis / Q000378:metabolism*; D002614:Chelating Agents / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D013885:Thiosulfates / Q000378:metabolism*; D014511:Uremia / Q000150:complications / Q000188:drug therapy*
chemical_list: D002614:Chelating Agents; D013885:Thiosulfates; C017717:sodium thiosulfate