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Related Experiment Videos

Cutaneous necrosis from calcific uremic arteriolopathy

T Coates1, G S Kirkland, R B Dymock

  • 1Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 18, 1998
PubMed
Summary

Calcific uremic arteriolopathy (calciphylaxis) is a severe complication of chronic kidney disease. Significant weight loss and warfarin use are identified as key risk factors for this condition.

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Area of Science:

  • Nephrology
  • Dermatology
  • Pathology

Background:

  • Calcific uremic arteriolopathy (calciphylaxis) is a rare but serious complication in patients with chronic renal failure.
  • It is characterized by painful skin necrosis and has a high mortality rate.

Purpose of the Study:

  • To report on 16 patients with calcific uremic arteriolopathy.
  • To identify clinical factors, pathological findings, and outcomes associated with the condition.
  • To review current understanding of pathogenesis and treatment.

Main Methods:

  • Retrospective case series of 16 patients diagnosed between 1985 and 1996.
  • Clinical data collection including patient history, presenting symptoms, and outcomes.
  • Skin biopsy and histopathological analysis, including electron microscopy and spectral analysis of mineral content.

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Main Results:

  • All patients presented with painful livedo reticularis progressing to cutaneous necrosis.
  • High mortality (14/16 patients) due to sepsis, cardiac arrest, and other complications.
  • Identified risk factors included warfarin therapy (7/16) and significant weight loss (>10% body weight) in the preceding 6 months (7/16).
  • Histopathology revealed calcific panniculitis and small vessel calcification with calcium and phosphorus as the primary mineral components.
  • Two patients showed improvement after switching from warfarin to low molecular weight heparin.

Conclusions:

  • Calcific uremic arteriolopathy is associated with high morbidity and mortality, causing ischemic tissue necrosis.
  • Significant weight loss and warfarin therapy are notable risk factors.
  • Further investigation into hyperbaric oxygen therapy as a potential treatment is warranted.