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Clinical management of nonuremic calcific arteriolopathy: a report of three cases
1Froedtert and the Medical College of Wisconsin Community Hospital Division, Wound and Ostomy, Menomonee Falls, WI.
Insights
Non-uremic calcific arteriolopathy (NUC) can be successfully managed with multimodal treatment including wound care and infection control. Intravenous sodium tetradecyl sulfate (STS) and negative pressure wound therapy (NPWT) may expedite healing in NUC patients.
Area of Science:
- Vascular Biology
- Dermatology
- Nephrology
Background:
- Calcific arteriolopathy, characterized by calcium salt deposition in vasculature, causes ischemia and necrosis.
- While often linked to end-stage renal disease (ESRD), it can occur in non-uremic patients (NUC).
- NUC management is challenging, often requiring a multidisciplinary approach.
Observation:
- This case series details the clinical presentation and treatment of three NUC patients in an outpatient wound center.
- Presumed contributing factors included CKD-associated mineral bone disorder, calcification inhibitor deficiencies, autoimmune dysfunction, and chronic inflammation.
- All patients received wound hygiene, pain management, and infection control; one also received negative pressure wound therapy (NPWT).
Findings:
- All patients achieved complete epithelialization with no long-term functional impairment.
- Wound infections were noted in all cases, with an average healing time of 20 weeks.
- Multimodal treatment, including wound care and infection control, proved effective.
Implications:
- Successful NUC management is achievable with intravenous sodium tetradecyl sulfate (STS), prompt infection treatment, pain control, and wound hygiene.
- NPWT may serve as an effective adjunct therapy to accelerate healing in NUC patients.
- This approach offers a viable strategy for improving outcomes in NUC cases.
Introduction:
Calcific arteriolopathy involves the deposition of insoluble calcium salts in the vasculature and soft tissues, leading to ischemia, thrombosis, and cutaneous necrosis. Calcific arteriolopathy is commonly associated with ESRD but can also occur outside of ESRD, known as NUC.
Objective:
This article reviews the clinical management and outcomes of 3 cases of non-uremic calcific arteriolopathy.
Materials And Methods:
This case series describes the clinical presentation and successful treatment of NUC in a community hospital-based outpatient wound center in southeastern Wisconsin. Factors presumed to be involved included chronic kidney disease-associated mineral bone disorder, dysregulation and deficiencies of the inhibitors of vascular calcifications, autoimmune dysfunction, and chronic inflammation. All 3 patients received multimodal treatment with wound hygiene, pain management, and infection control. In addition to these interventions, case 2 received NLFU.
Results:
All 3 patients displayed increased tolerance of compression and debridement and successfully epithelialized with no discernible effect on long-term function or quality of life. Wound infection occurred in each case. The mean overall healing time was 20 weeks.
Conclusion:
The study findings suggest that successful management of NUC can be achieved using IV STS, early and aggressive infection treatment, pain control, and wound hygiene. In patients with NUC, NLFU may be an appropriate adjunct to expedite healing.
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