Calciphylaxis responsive to lanthanum carbonate (FOSRENOL) therapy

Calciphylaxis is a rare and debilitating vasculopathy predominantly seen in patients with renal failure. The proposed mechanism of injury is active vascular calcification with associated elevated parathyroid hormone, hypercalcemia, or hyperphosphatemia. With improved pharmacologic agents including non-calcium containing phosphate binders, vitamin D analogues, calcimimetics, and bisphosphonates, targeted therapy on the mineralization process has been tried with varied success. We report a case of biopsy-proven calciphylaxis in a patient with acute kidney injury requiring dialysis that had persistently elevated calcium-phosphorus product refractory to treatment. The patient, however, responded rapidly to the initiation of lanthanum carbonate therapy and modified dialysis. This is the first known case reported in the literature utilizing this new non-calcium-based phosphate binder in the setting of calciphylaxis.