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Kidney Week

Abstract: PO0567

A Case of Severe Penile Pain

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Joab, Tatyana Mary Jacqui, Lenox Hill Hospital, New York, New York, United States
  • Barta, Valerie Suzanne, Lenox Hill Hospital, New York, New York, United States
Introduction

Calciphylaxis is a rare disease with skin necrosis, tissue ischemia and small to medium-sized vessel calcium (Ca) deposition and thrombosis. The prevalence of penile calciphylaxis is 0.24% in end stage kidney disease (ESKD). Given its rarity and location, it can be difficult to diagnose and has a poor prognosis. Identifying it is imperative.

Case Description

56 year old male with ESKD on hemodialysis (HD) due to diabetes mellitus with secondary hyperparathyroidism and peripheral vascular disease was admitted with a painful, necrotic penile lesion for 1 month. Since starting HD 1 year prior, his serum phosphorous ranged 7.8-9.0mg/dL, Ca 8.0-9.0mg/dL and parathyroid hormone downtrended from 611 to 127pg/mL on hectorol, phoslo and Ca carbonate. CTA showed atherosclerotic stenosis of internal pudendal arteries with patent penile arteries. Interventional angiogram showed severe stenosis occluding distal pudendal arteries. After consensus with nephrology, interventional radiology, vascular surgery, urology, dermatology and infectious disease, the diagnosis of penile calciphylaxis was made. Treatment goals included phosphate normalization by 4 weekly HD sessions, low Ca dialysate, non Ca based phosphate binders; vasodilators sildenafil and pentoxifylline, and sodium thiosulphate (blocks calcification of smooth muscle cells). He is in a clinical trial for SNF472, a selective calcification inhibitor, for wound healing and pain management. His severe pain has resulted in disability and income loss.

Discussion

Penile calciphylaxis is associated with hyperparathyroidism, ESKD, and normal body mass index. Neither parathyroidectomy nor penectomy have shown mortality benefits and current treatments are not based on interventional trials. Kidney transplant may be curative. It is essential that we identify penile calciphylaxis, given its significant morbidity and mortality.

Penile calciphylaxis