Calciphylaxis: Difference between revisions
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==Background== | ==Background== | ||
*Most commonly | *Most commonly seen in ESRD patients on hemodialysis (~1%) | ||
**Seen almost exclusively in patients with Stage 5 chronic kidney disease | **Seen almost exclusively in patients with Stage 5 chronic kidney disease | ||
*No available data in general population (non-uremic calciphylaxis) | *No available data in general population (non-uremic calciphylaxis) | ||
| Line 7: | Line 7: | ||
*Mortality as high as 60-80%; sepsis from necrotic skin lesions | *Mortality as high as 60-80%; sepsis from necrotic skin lesions | ||
==Features== | ==Clinical Features== | ||
*Very painful lesions develop suddenly and progress rapidly | *Very painful lesions develop suddenly and progress rapidly | ||
*Dermatolgic appearances: | *Dermatolgic appearances: | ||
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**Wound VAC | **Wound VAC | ||
**Total or subtotal parathyroidectomy | **Total or subtotal parathyroidectomy | ||
==Disposition== | |||
*Admit | |||
==See Also== | |||
[[Dialysis complications]] | |||
==References== | |||
<References/> | |||
[[Category:FEN]] | [[Category:FEN]] | ||
[[Category:Derm]] | [[Category:Derm]] | ||
Revision as of 09:25, 25 July 2015
Background
- Most commonly seen in ESRD patients on hemodialysis (~1%)
- Seen almost exclusively in patients with Stage 5 chronic kidney disease
- No available data in general population (non-uremic calciphylaxis)
- Calcium and phosphate levels rise beyond solubility and precipitate in arteries
- May be increasing due to widespread IV vitamin D
- Mortality as high as 60-80%; sepsis from necrotic skin lesions
Clinical Features
- Very painful lesions develop suddenly and progress rapidly
- Dermatolgic appearances:
- Livedo reticularis
- Stellate purpura
- Usually LEs, hands, or torso
Differential Diagnosis
- Brown recluse spider bite
- Bullous Pemphigoid
- Cellulitis, necrotizing fasciitis
- Erythema Nodosum
- Vasculitis
- Venous ulcers
- Hypercalcemia
- Hyperphosphatemia
- Nephrogenic systemic fibrosis (MRI w/ gadolinium in dialysis pt)
Diagnosis
Labs
- Serum PTH level
- CBC, CMP, phosphate, coags
- Inpatient - hepatitis panel, cryofibrinogen level, lipase, ESR, CRP, ANA, ANCA
Imaging
- Plain radiographs - arborization of vascular calcification within dermis and subQ tissues
Management
- Rigorous and continuous control of phosphate and calcium balance
- Medical
- Discontinue calcium increasing interventions
- Increase dialysis frequency
- Calcimimetics in hyperparathyroidism
- Bisphosphonates
- Sodium thiosulfate - off-label, increases solubility of calcium deposits
- Fix hypercoagulability
- Surgical
- Aggressive wound care and debridement of necrotic tissues
- Wound VAC
- Total or subtotal parathyroidectomy
Disposition
- Admit