Calciphylaxis and subtotal parathyroidectomy: a double-edged sword

Hemodial Int. 2013 Oct;17 Suppl 1:S33-6. doi: 10.1111/hdi.12087.

Abstract

Calciphylaxis, also called calcific uremic arteriolopathy is a dreadful, life-threatening ischemic vasculopathy, primarily involving skin and subcutaneous tissue, mostly on patients with end-stage kidney disease. Calciphylaxis is a well-described, but still a poorly understood disorder of mineral metabolism. Its occurrence is rare, but increasingly reported. We describe a 62-year-old obese lady on hemodialysis for end-stage kidney disease due to type 2 diabetes, who developed two episodes of calciphylactic skin lesions during the 3 years observation. The healing of lesions in the first episode was prompted by a subtotal parathyroidectomy for severe secondary hyperparathyroidism. However, the resumption of oral calcium and vitamin D analog for the parathyroidectomy-related hypocalcemia induced another occurrence of widespread calciphylactic skin lesions in areas of great adiposity. The typical regimen of IV sodium thiosulfate brought a successful outcome to the second episode. Now, growing numbers of successful treatment for calciphylaxis are reported with more specific therapies and a clear understanding of the pathogenetic mechanism is in sight.

Keywords: Calciphylaxis; end stage kidney disease; hemodialysis; hypocalcemia; parathyroidectomy; sodium thiosulfate.

Publication types

  • Case Reports

MeSH terms

  • Calciphylaxis / complications
  • Calciphylaxis / pathology
  • Calciphylaxis / surgery*
  • Female
  • Humans
  • Hyperparathyroidism / complications
  • Hyperparathyroidism / surgery
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy
  • Middle Aged
  • Parathyroidectomy / methods*
  • Renal Dialysis
  • Skin Diseases / complications
  • Skin Diseases / pathology
  • Skin Diseases / surgery*