Acute calciphylaxis precipitated by the initiation of hemodialysis
| Autor: | J. Jones, Pablo Casares, Germaine Chan, Aditi Ranade, Daniela Guisado, Steven D. Smith, Gagangeet Sandhu, Levy I Amar |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Biopsy chemistry.chemical_element Calcium Gastroenterology End stage renal disease Diagnosis Differential Renal Dialysis Internal medicine Vitamin D and neurology Medicine Humans Acidosis Skin Calciphylaxis Metastatic calcification business.industry General Medicine Middle Aged medicine.disease chemistry Nephrology Acute Disease Kidney Failure Chronic Female Hemodialysis medicine.symptom business Complication |
| Zdroj: | Clinical nephrology. 80(4) |
| ISSN: | 0301-0430 |
| Popis: | Calciphylaxis, or calcific uremic arteriopathy (CUA), is characterized by metastatic calcification in the media of small arteries and arterioles leading to cutaneous necrosis. It is most commonly seen in patients with end stage renal disease who have elevated serum calcium × phosphorus (Ca × P) product. Normalization of Ca × P product is considered paramount in the prevention and treatment of CUA. We describe a novel presentation of CUA in which a Stage-5 CKD patient developed signs and symptoms of CUA immediately after initiation of hemodialysis (HD). We postulate that an influx of calcium from the dialysate into the patient's blood, in addition to correction of her acidosis, led to abundant substrate in a favorable milieu for Ca-P complex formation at the time of her first HD session. Our case is the first reported case of HD associated iatrogenic acute CUA. To avoid this complication, we should maintain adequate hydration,use lower calcium dialysate, and avoid vitamin D analogues and calcium-containing medications when initiating HD in patients with high Ca-P product. Since sodium thiosulfate is known to prevent precipitation of Ca-P complexes, its empiric use during initial HD treatments may be effective in preventing CUA, a potentially fatal disease. |
| Databáze: | OpenAIRE |
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