Abstract: SA-PO285
The Specificity of Histology in Calciphylaxis
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
Authors
- Ellis, Carla L., Emory University Hospital, Atlanta, Georgia, United States
- Cheeley, Justin Thomas, Emory University School of Medicine, Atlanta, Georgia, United States
- O'Neill, W. Charles, Emory University, Atlanta, Georgia, United States
Background
Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a devastating skin lesion that occurs most commonly in end-stage renal disease (ESRD). We previously showed that many of the histologic findings considered diagnostic of CUA can also be seen in normal skin from amputations in unaffected ESRD patients, raising questions about their specificity. To address this with more appropriate control tissue, we compared affected and unaffected skin from patients with a clinical diagnosis of CUA.
Methods
Hospitalized patients were recruited by the consulting dermatologist, who then performed skin biopsies of the lesion and of normal skin on the contralateral extremity. Skin tissue was obtained at autopsy in 2 cases. Hematoxylin and eosin and von Kossa stains were examined on each specimen. Histologic findings were evaluated by a single pathologist and included small vessel calcification, small vessel thrombosis, intimal hyperplasia, and extravascular calcification.
Results
Paired skin samples were obtained from 7 patients, of whom 4 were female, 5 were diabetic, 3 were receiving warfarin, 6 were receiving hemodialysis, and 1 was receiving peritoneal dialysis. Age range was 39-77. Lesions were located on the leg (4), thigh (2), and penis (1). In the latter case, control tissue was obtained from the mons pubis. The prevalence of findings in affected skin were: 5/7 (71%) small vessel calcification, 3/7 (43%) small vessel thrombosis, and 2/7 (30%) intimal hyperplasia, and 2/7 (30%) extravascular calcification. None of these findings were present in two biopsies. At least 2 findings were present in each of the other 5 specimens. Unaffected skin showed no abnormalities in the biopsies and only vascular calcification in the autopsy samples.
Conclusion
Based on this small study, histologic findings associated with CUA are absent in biopsies of unaffected skin from patients with suspected CUA. While small vessel calcification was noted in normal skin in the autopsy cases (possibly due to the larger sampling size), none of the other findings were present. Thus, the presence of at least 2 histologic findings appeared to be specific for CUA. Reconciling this with our previous results using amputation specimens as controls, we conclude that CUA is associated with specific histologic findings but only in patients without peripheral arterial disease. However, additional cases are needed to confirm this.
Funding
- Clinical Revenue Support