Calciphylaxis, early identification and management: a report of 2 cases

Edwards, Harrison A., Barnes, Chadwick E., and Gitomer, Jeremy J. (2013) Calciphylaxis, early identification and management: a report of 2 cases. In: Posters from the Australasian College of Dermatologists Biennial Spring Conference. From: Australasian College of Dermatologists Biennial Spring Conference, 3-6 October 2013, Cairns, QLD, Australia.

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Abstract

Patients with end-stage renal disease often suffer from dermatological disorders secondary to uraemic complications, ranging from uncomfortable to life-threatening.

Calcific uraemic arteriolopathy (CUA), or calciphylaxis, is a life-threatening calcification of arterioles leading to necrotic infarcts of the skin and subcutaneous tissue (panniculus adiposus) with a high potential to progress to bacterial sepsis and death. The incidence of CUA is approximately 4.1% in patients on dialysis with the reported incidence increasing over the past 10 years.

CUA is associated with significant morbidity and high mortality. Data is limited, but studies suggest an 8-fold increase in the risk of death compared to controls and a one year cause-specific survival rate of 45.8%.

Early signs: Sudden onset of erythema and livedo reticularis pattern commonly on the abdomen, hips and thighs, followed in several days by palpable, painful, pre-ulcerative, subcutaneous plaques with surrounding pruritic areas. Subsequently, these areas ulcerate revealing regions of necrotic subcutaneous adipose tissue covered by eschars.

Risk Factors: Female, Caucasian, obesity, diabetes mellitus, time on dialysis, systemic corticosteroid use, laboratory findings: low serum albumin, elevated serum phosphate, elevated serum alkaline phosphatase.

Management: Aggressive wound care consisting of frequent debridement, vacuum dressings and systemic antibiotics; pain management and maintenance of good nutrition; oral and intravenous bisphosphonates and hyperbaric oxygen therapy.

Optimally, CUA is prevented; early diagnosis significantly improves the prognosis, therefore the diagnostician must maintain a high degree of suspicion with patients showing early dermatological, pre-ulcerative signs of CUA. Diagnosis is initially clinical with later histological confirmation of vascular calcification and fibrosis.

Item ID: 40577
Item Type: Conference Item (Poster)
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A published abstract is also available from the Related URLs link below and can be cited as:

Edwards, H.A., Barnes, C.E. (2013) Calciphylaxis, early identification and management: a report of 3 cases. Australasian Journal of Dermatology. 54 (S3). pp. 13.

Date Deposited: 18 Sep 2015 02:33
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110304 Dermatology @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110312 Nephrology and Urology @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920117 Skin and Related Disorders @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920119 Urogenital System and Disorders @ 50%
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