A Rare and Painful Byproduct of ESRD

​BY HABIR MANDAIR; KEYUR KURANI; & KHALID MALIK, MDA 62-year-old obese woman with end-stage renal disease (ESRD) who was on hemodialysis, hypertension, diabetes mellitus, and chronically elevated serum calcium levels presented to the ED with altered mental status. Nursing home staff stated that she was unable to answer questions coherently and seemed confused.Her vitals were within normal limits except for a body temperature of 99.9°F. Several necrotic lesions of various sizes were found on her left and right buttocks and the medial aspects of both thighs. The patient also had severe necrosis of the third finger on her left hand and the second on her right hand. Calciphylaxis was suspected because of her history and the unique characteristics of the lesions.Lab results showed a serum calcium level of 13.6 mg/dL, a PTH of 102.2 pg/mL, and elevated vitamin D levels. The patient was admitted and treated by wound care, nephrology, and endocrinology. Medications and dialysis regimen were also adjusted to achieve adequate serum calcium control.Recognition and Risk FactorsCalcific uremic arteriopathy (CUA), the more accurate name for calciphylaxis, is a rare disorder resulting from impaired calcium and phosphate homeostasis most often found in ESRD patients. Metastatic calcification of blood vessels isn't uncommon in ESRD patients, but CUA is distinctly different because it selectively targets dermal and subcutaneous arterioles in areas of high adiposity, as seen in the thigh...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research