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CEN Case Reports

, Volume 7, Issue 2, pp 204–207 | Cite as

Penile calciphylaxis in a patient on combined peritoneal dialysis and hemodialysis

  • Takahiro Kasai
  • Naoki Washida
  • Hirokazu Muraoka
  • Kentarou Fujii
  • Kiyotaka Uchiyama
  • Keisuke Shinozuka
  • Kohkichi Morimoto
  • Hirobumi Tokuyama
  • Shu Wakino
  • Hiroshi Itoh
Case Report
  • 61 Downloads

Abstract

Calciphylaxis presents with painful purpura and intractable skin ulcers on the trunk and particularly the distal extremities, and it mainly occurs in patients on chronic dialysis. A 66-year-old man with renal failure due to diabetic nephropathy was on peritoneal dialysis alone for 1 year, followed by peritoneal dialysis combined with hemodialysis for 3 years. He developed calciphylaxis of the penis, which was diagnosed from the skin biopsy findings and clinical observation. To treat this condition, PD was stopped and HD was performed three times a week. In addition, warfarin therapy was discontinued and infusion of sodium thiosulfate was performed. The penile ulcers decreased in size and pain was markedly improved, so the patient was discharged from hospital. Following discharge, PD was resumed after changing the peritoneal dialysis fluid to bicarbonate-buffered dialysate. The penile ulcers eventually resolved completely. There have been very few reports about calciphylaxis in patients on combined dialysis modalities. In our patient, penile calciphylaxis progressed when lactate-buffered peritoneal dialysis fluid was used and resolved after switching to bicarbonate-buffered fluid together with cessation of warfarin therapy and infusion of sodium thiosulfate.

Keywords

Calciphylaxis Combined PD/HD therapy Bicarbonate-buffered PD fluid 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no financial conflicts of interest to declare.

Human rights

All procedures performed in studies involving this participant was in accordance with the ethical standards of the institutional and national research committee at which the studies were conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient included in this study.

References

  1. 1.
    Rogers NM, Coates PT. Calcific uraemic arteriolopathy: an update. Curr Opin Nephrol Hypertens. 2008;17(6):629–34.CrossRefGoogle Scholar
  2. 2.
    Weenig RH. Pathogenesis of calciphylaxis: Hans Selye to nuclear factor k-B. J Am Acad Dermatol. 2008;58(3):458–71.CrossRefGoogle Scholar
  3. 3.
    Daudén E, Oñate MJ. Calciphylaxis. Dermatol Clin. 2008;26(4):557–68.CrossRefGoogle Scholar
  4. 4.
    Ng AT, Peng DH. Calciphylaxis. Dermatol Ther. 2011;24(2):256–62.CrossRefGoogle Scholar
  5. 5.
    New N, Mohandas J, John GT, et al. Calcific uremic arteriolopathy in peritoneal dialysis populations. Int J Nephrol. 2011;2011:982854.CrossRefGoogle Scholar
  6. 6.
    Ramani R, Ramachandran A, Ravindran S, Kurian GA. Erythrocyte membrane bound atpase and antioxidant enzyme changes associated with vascular calcification is reduced by sodium thiosulfate. Indian J Clin Biochem. 2017;32(4):487–92.CrossRefGoogle Scholar
  7. 7.
    Bleyer AJ, Choi M, Igwemezie B, de la Torre E, White WL. A case–control study of proximal calciphylaxis. Am J Kidney Dis. 1998;32(3):376–83.CrossRefGoogle Scholar
  8. 8.
    Mazhar AR, Johnson RJ, Gillen D, Stivelman JC, Ryan MJ, Davis CL, Stehman-Breen CO. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney Int. 2001;60(1):324–32.CrossRefGoogle Scholar
  9. 9.
    Fine A, Zacharias J. Calciphylaxis is usually nonulcerating: risk factors, outcome and therapy. Kidney Int. 2002;61(6):2210–7.CrossRefGoogle Scholar
  10. 10.
    Weenig RH, Sewell LD, Davis MD, McCarthy JT, Pittelkow MR. Calciphylaxis: natural history, risk factor analysis, and outcome. J Am Acad Dermatol. 2007;56(4):569–79.CrossRefGoogle Scholar
  11. 11.
    Ando R. Skin complications associated with dialysis 3. Calciphylaxis. Jpn J Clin Dial 2009;25(7):126–34 (in Japanese).Google Scholar
  12. 12.
    Paul S, Carlos AR, Vedak P, et al. The role of bone scintigraphy in the diagnosis of calciphylaxis. JAMA Dermatol. 2017;153(1):101–3.CrossRefGoogle Scholar
  13. 13.
    Pliquentt RU, Schwock J, Padchke R, Achenbach H. Calciphylaxis in chronic, non-dialysis-dependent renal disease. BMC Nephrol. 2003;4:8.CrossRefGoogle Scholar
  14. 14.
    Zhang Y, Corapi KM, Luongo M, Nigwekar SU. Calciphylaxis in peritoneal dialysis patients: a single cohort study. Int J Nephrol Renovasc Dis. 2016;9:235–41.CrossRefGoogle Scholar
  15. 15.
    Angelis M, Wong LL, Myers SA, Wong LM. Calciphylaxis in patients on hemodialysis: a prevalence study. Surgery. 1997;122(6):1083–9.CrossRefGoogle Scholar
  16. 16.
    Dosanjh A, Kebebew E. Calciphylaxis. Rare but Fatal. Curr Surg. 2005;62(5):455–8.CrossRefGoogle Scholar
  17. 17.
    Chen W, Abramowitz MK. Treatment of metabolic acidosis in patients with CKD. Am J Kidney Dis. 2014;63(2):311–7.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Takahiro Kasai
    • 1
  • Naoki Washida
    • 1
    • 2
  • Hirokazu Muraoka
    • 1
  • Kentarou Fujii
    • 1
  • Kiyotaka Uchiyama
    • 1
  • Keisuke Shinozuka
    • 1
  • Kohkichi Morimoto
    • 1
  • Hirobumi Tokuyama
    • 1
  • Shu Wakino
    • 1
  • Hiroshi Itoh
    • 1
  1. 1.Department of Internal Medicine, School of MedicineKeio UniversityTokyoJapan
  2. 2.Department of NephrologyInternational University of Health and Welfare HospitalNasushiobaraJapan

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