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Kidney Week

Abstract: SA-PO057

Calciphylaxis Associated With AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Jenkinson, Patrick J., Spectrum Health Lakeland, Saint Joseph, Michigan, United States
  • Thilakaratne, Dihan, Spectrum Health Lakeland, Saint Joseph, Michigan, United States
  • Kwon, Katherine Westin, Spectrum Health Lakeland, Saint Joseph, Michigan, United States
  • Al-Shweiat, Wajdi, Spectrum Health Lakeland, Saint Joseph, Michigan, United States
Introduction

Calciphylaxis, also known as calcific uremic arteriopathy, is a disease that carries high mortality and morbidity. It is predominantly found in patients with end-stage kidney disease and is associated with a myriad of risk factors, including hyperphosphatemia, calcitriol therapy, warfarin therapy, diabetes, and female gender. We report a case of biopsy-proven calciphylaxis that developed in a patient with acute kidney injury.

Case Description

A 79-year-old woman with a past medical history significant for atrial fibrillation on apixaban, chronic kidney disease stage four with a recent Clostridium difficile infection not fully resolved, presented with chest pain, fatigue, shortness of breath, and vomiting. The patient was found to have acute kidney injury, anion gap metabolic acidosis, and hyperkalemia. A urinary catheter was placed with minimal return of urine. A fluid challenge of 500 mL crystalloid did not lead to increased urine output. Computed Tomography of the abdomen and pelvis was unremarkable for obstruction or any structural renal abnormality. Urinalysis revealed bacteria, proteinuria, pyuria and hyaline casts. Hemodialysis was initiated, but had to be terminated due to hypotension and pain in the lower extremities. Subsequent dialysis sessions also had to be cut short due to continued pain exacerbated by dialysis. Patient’s renal function did not improve, with persistent hyperkalemia and anuria. During the hospitalization, the patient developed painful purpuric lesions on the legs bilaterally which converted to confluent hemorrhagic bullae. The lesions were biopsied and revealed calciphylaxis with acute inflammation. Due to the significant ongoing pain, and complicated medical comorbidities, the patient ultimately elected comfort measures.

Discussion

This case demonstrates a rare presentation of calciphylaxis from acute kidney injury. It is known that calciphylaxis carries a high mortality and morbidity. Pain control and discontinuing possible exacerbating medications is essential in initial management. Treatment consists of a multidisciplinary approach to treat pain, prevent infection and prevent progression with medical therapies such as sodium thiosulfate. Despite these therapies, the mortality from calciphylaxis remains high and diagnosis portends a grim prognosis.