International Urology and Nephrology

, Volume 40, Issue 2, pp 443–451 | Cite as

Calciphylaxis: calcific uremic arteriolopathy and the emerging role of sodium thiosulfate

  • Melvin R. HaydenEmail author
  • David Goldsmith
  • James R. Sowers
  • Ramesh Khanna
Nephrology - Review


Calciphylaxis–calcific uremic arteriolopathy, is a serious disorder of arteriolar calcification of the arteriole media and is associated with endovascular fibrosis and thrombosis in subcutaneous adipose tissue. It frequently results in severe ischemia, intense pain, and tissue necrosis with nonhealing skin ulcerations. It usually occurs in chronic kidney disease and especially in patients requiring renal replacement therapy. It is associated with a very high mortality rate, and the number of reports and reviews seemed to have increased over the past 5 years. Advances in therapy and salvaging patients from this high mortality risk have recently been reported with the use of sodium thiosulfate. The new application for this old drug used to treat cyanide poisoning and recently preventing neurotoxic effects resulting in hearing loss in those patients with head and neck cancer receiving cisplatin and carboplatin therapy are discussed. Recently, multiple case reports have demonstrated that sodium thiosulfate therapy has resulted in rapid pain relief, healing of skin ulcerations, and prevention of high mortality risk. This emerging treatment and its success are relatively unknown to many physicians. The purpose of this report is to share with others the emerging role of sodium thiosulfate and its new application as a treatment option to be used in combination with other treatment modalities for calciphylaxis–calcific uremic arteriolopathy. Indeed, as with any new treatment this emerging therapy should be studied in greater detail, but this old drug seems to have a new life in the hands of treating physicians.


Antioxidant Calciphylaxis Calcium chelation eNOS uncoupling Glutathione (GSH) Hydrogen sulfide (H2S) Sodium thiosulfate 


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Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Melvin R. Hayden
    • 1
    Email author
  • David Goldsmith
    • 2
  • James R. Sowers
    • 1
    • 3
  • Ramesh Khanna
    • 4
  1. 1.Department of Internal Medicine, Endocrinology Diabetes and Metabolism, Diabetes and Cardiovascular Disease Research GroupUniversity of Missouri School of Medicine, Health Sciences CenterColumbiaUSA
  2. 2.Guy’s HospitalLondonUK
  3. 3.Department of Physiology and PharmacologyUniversity of Missouri School of MedicineColumbiaUSA
  4. 4.Department of Internal MedicineUniversity of Missouri School of MedicineColumbiaUSA

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