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Abstract: PO0566

Case Series of Penile Calciphylaxis in a Large Urban Hospital

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Solomon, Alfred T., Emory University School of Medicine, Atlanta, Georgia, United States
  • Mudunuru, Sitarama Arvind, Emory University School of Medicine, Atlanta, Georgia, United States
  • Navarrete, Jose E., Emory University School of Medicine, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
Background

Calciphylaxis or calcific uremic arteriolopathy (CUA) is a complex syndrome of deranged mineral metabolism and vascular calcification with subsequent tissue ischemia predominantly in end stage kidney disease(ESKD) patients on dialysis. The disease has been categorized as central or peripheral but in rare cases of peripheral calciphylaxis there may be penile involvement. Due to the paucity of data on penile calciphylaxis, this study was done to ascertain the characteristics, management and mortality of patients with this condition.

Methods

An observational study involving retrospective analysis of medical records of six(6) patients with biopsy proven penile calciphylaxis treated in a large urban hospital between January 2000 and March 2021 was performed.

Results

All patients with penile calciphylaxis had ESKD with mean duration on dialysis of 5.2±3.5 years. The mean age at diagnosis was 54±9.7 years. Sixty six percent of patients were African Americans with the remainder being Caucasians. Only one of six patients was obese with mean BMI of 23.2±5.5 kg/m2. Similarly only one patient was on warfarin. None of the patients was on systemic steroids or vitamin D at the time of diagnosis. All patients had secondary hyperparathyroidism with median PTH of 264.5pg/mL(IQR 175.5). Surprisingly all patients had normal calcium phosphate products with mean of 36.1±11.6mg2/dL2(normal range for our lab is 21.5-51.5).
Penectomy was performed in 4 patients and 2 patients had treatment with hyperbaric oxygen. The mean survival at diagnosis was 4.0±1.2 months. Mortality was 20% and 100% at 3 and 6 months post diagnosis respectively.

Conclusion

Penile calciphylaxis is a very rare entity. Although obesity has been associated with calciphylaxis, majority of our patients with penile calciphylaxis were not obese. Interestingly all our patients had normal calcium phosphate products suggestive of heterogeneous mechanisms in the pathophysiology of the disease. The PTH was lower than our previously reported level of 569pg/mL in our calciphylaxis database. Our mortality rate was very high with 100% mortality within six months of penile calciphylaxis diagnosis.