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Penile and digital calciphylaxis: A case report and literature review

Gonçalo Ávila, Patrícia Matias, Ivo Laranjinha

    Clinical Nephrology
    |May 22, 2023
    PubMed

    Insights

    Calcific uremic arteriolopathy (CUA) is a severe condition causing tissue death. Early diagnosis and treatment, including managing mineral metabolism, are crucial for improving outcomes in hemodialysis patients.

    Area of Science:

    • Nephrology
    • Vascular Medicine
    • Dermatology

    Background:

    • Calcific uremic arteriolopathy (CUA) is a rare vascular complication in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
    • CUA presents with painful skin necrosis and has a high mortality rate, often associated with dysregulation of calcium and phosphate metabolism.

    Approach:

    • This report details a case of a 58-year-old male on hemodialysis (HD) for obstructive uropathy-induced CKD.
    • The patient experienced distal penile ischemia followed by digital necrosis, diagnosed via skin biopsy confirming CUA.
    • Treatment involved surgical debridement, hyperbaric oxygen, intensified HD, phosphate control, and sodium thiosulfate administration.

    Key Points:

    • An unusual presentation of CUA occurred in a non-diabetic, non-anticoagulated patient shortly after initiating HD.
    • Severe dysregulation of calcium and phosphate metabolism was a key factor.
    • Successful management involved a multi-modal approach including intensified HD and sodium thiosulfate.

    Conclusions:

    • This case highlights the importance of recognizing CUA in hemodialysis patients, even with atypical initial presentations.
    • Aggressive management of mineral and bone disorder is critical for CUA treatment.
    • Sodium thiosulfate shows promise as a therapeutic option for CUA.

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