Abstract: SA-PO286
A Novel Approach to Treat Calciphylaxis, A Deadly Disease
Session Information
- Bone and Mineral Metabolism: Calcium, Magnesium, Kidney Stones
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Author
- Elsebaei, Mohammed Ibraheem, Al Amiri, Kuwait City, Kuwait
Introduction
Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare disease mostly occurring in patients with kidney disease (CKD). It is characterized by painful, indurated and ulcerative lesions often covered by dark eschar that is very tender and leads to necrosis following calcification and occlusion of small cutaneous arterioles. Lesions may be solitary or multiple, covering several body regions. The Prognosis is generally poor. Complications, septic episodes are common and explain the high mortality rate of about 45–80% particularly in patients with ulcerative disease [1]. We report a new therapeutic approach .
Case Description
A 66-years-old woman with known CKD stage 3 secondary to diabetic nephropathy, hypertension, coronary artery disease, hyperlipidemia and bronchial asthma . There was no history of any medication allergies. The patient presented to our hospital with urinary tract infection, which was complicated with acute deterioration of her renal function approaching ESRD. Her hospital stay was complicated with appearance of multiple red indurated skin lesions of variable sizes which were progressive. They were markedly painful and required strong Opiods for pain relief. These skin lesions were rapidly progressed to deep ulcers and were requiring multiple surgical debridement’s. Skin biopsy was done and confirmed the diagnosis of calciphylaxis. She was supported with hemodialysis. Her labs showed. s PTH level of 30 pmol/l, scalcium was 2.4 u mol/l and s phos was 2.2 umol/l.
Discussion
The patient was Initially treated with intravenous sodium thiosulphate after each dialysis session, oral cinacalcet, oral sevelamer and low
calcium dialysate. With These measures there was no relief of her lesions and pain.As a last resort Nitroderm patches (5 inches) and silver Alginate dressings were applied locally and she was given oral nifidepine 30 Mg LA once a day. Patient demonstrated a dramatic improvement over the subsequent months.Conclusions: This case illustrates that the local and systemic vasodilators including other general measures could be successfully used in managing resistant cases of calciphylaxis. This therapeutic approach should be evaluated in other such cases to revalidate.
1st 2 pics before ttt - After ttt -Skin biopsy