Skip to main content

Ulcers Caused by Calciphylaxis

  • Chapter
  • First Online:
Uncommon Ulcers of the Extremities

Abstract

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and life-threatening disorder that usually occurs in patients with end-stage renal disease (ESRD) and less frequently in non-uremic patients [1–3].

The term calciphylaxis, first coined by Dr. Seyle in 1961, literally means “protection by calcification.” Dr. Seyle described calciphylaxis in rats as an adaptive (phylatic) response that leads to calcium deposition in the affected tissues [4]. In 1963, Eisenberg and Bartholow reported a case of extensive metastatic calcification in a patient with chronic renal failure, which represented the human counterpart of calciphylaxis [5]. Over the course of the following years several cases of calciphylaxis have been described [6–10].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Brandenburg VM, Cozzolino M, Mazzaferro S. Calcific uremic arteriolopathy: a call for action. Semin Nephrol. 2014;34:641–7.

    PubMed  Google Scholar 

  2. Nigwekar SU, Kroshinsky D, Nazarian RM, et al. Calciphylaxis: risk factors, diagnosis, and treatment. Am J Kidney Dis. 2015;66:133–46.

    PubMed  PubMed Central  Google Scholar 

  3. Nigwekar SU. Multidisciplinary approach to calcific uremic arteriolopathy. Curr Opin Nephrol Hypertens. 2015;24:531–7.

    CAS  PubMed  Google Scholar 

  4. Selye H, Gentile G, Prioreschi P. Cutaneous molt induced by calciphylaxis in the rat. Science. 1961;134(3493):1876–7.

    CAS  PubMed  Google Scholar 

  5. Eisenberg E, Bartholow PV Jr. Reversible calcinosis cutis: calciphylaxis in man. N Engl J Med. 1963;268(22):1216–20.

    Google Scholar 

  6. Rees JK, Coles GA. Calciphylaxis in man. BMJ. 1969;2(5658):670–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Edelstein CL, Wickham MK, Kirby PA. Systemic calciphylaxis presenting as a painful, proximal myopathy. Postgrad Med J. 1992;68(797):209–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Bargman JM, Prichard SS. A usual peritoneal dialysis patient with an unusual skin disease. Perit Dial Int. 1995;15(6):252–8.

    CAS  PubMed  Google Scholar 

  9. Budisavljevic MN, Cheek D, Ploth DW. Calciphylaxis in chronic renal failure. J Am Soc Nephrol. 1996;7(7):978–82.

    CAS  PubMed  Google Scholar 

  10. Richens G, Piepkorn MW, Krueger GG. Calcifying panniculitis associated with renal failure. A case of Selye’s calciphylaxis in man. J Am Acad Dermatol. 1982;6(4 Pt 1):537–9.

    CAS  PubMed  Google Scholar 

  11. Nigwekar SU, Thadhani R, Brandenburg VM. Calciphylaxis. N Engl J Med. 2018;378(18):1704–14.

    CAS  PubMed  Google Scholar 

  12. Fine A, Zacharias J. Calciphylaxis is usually non-ulcerating:riskfactors, outcome and therapy. Kidney Int. 2002;61(6):2210–7.

    PubMed  Google Scholar 

  13. Anderson DC, Stewart WK, Piercy DM. Calcifying panniculitis with fat and skin necrosis in a case of uraemia with autonomous hyper parathyroidism. Lancet. 1968;2:323–5.

    CAS  PubMed  Google Scholar 

  14. Kodumudi V, Jeha GM, Mydlo N, Kaye AD. Management of cutaneous calciphylaxis. Adv Ther. 2020;37(12):4797–807.

    PubMed  PubMed Central  Google Scholar 

  15. Westphal SG, Plumb T. Calciphylaxis. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2018; https://www.ncbi.nlm.nih.gov/books/NBK519020. Accessed 12 Nov 2018.

    Google Scholar 

  16. Nigwekar SU. Calciphylaxis. Curr Opin Nephrol Hypertens. 2017;26:276–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Angelis M, Wong LL, Myers SA, Wong LM. Calciphylaxis in patients on hemodialysis: a prevalence study. Surgery. 1997;122(6):1083–9; discussion 1089–90.

    CAS  PubMed  Google Scholar 

  18. Nigwekar SU, Zhao S, Wenger J, et al. A nationally representative study of calcific uremic arteriolopathy risk factors. J Am Soc Nephrol. 2016;27:3421–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Hayashi M, Takamatsu I, Kanno Y, et al. A case-control study of calciphylaxis in Japanese end-stage renal disease patients. Nephrol Dial Transplant. 2012;27:1580–4.

    CAS  PubMed  Google Scholar 

  20. Kalajian AH, Malhotra PS, Callen JP, Parker LP. Calciphylaxis with normal renal and parathyroid function: not as rare as previously believed. Arch Dermatol. 2009;145(4):451–8.

    PubMed  Google Scholar 

  21. Nigwekar SU, Wolf M, Sterns RH, Hix JK. Calciphylaxis from nonuremic causes: a systematic review. Clin J Am Soc Nephrol. 2008;3(4):1139–43.

    PubMed  PubMed Central  Google Scholar 

  22. Ramsey-Stewart G. Eutrophication: spontaneous progressive dermatoliponecrosis. A fatal complication of gross morbid obesity. Obes Surg. 1992;2(3):263–4.

    CAS  PubMed  Google Scholar 

  23. Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care. 2019;28(Sup6):S1–S92.

    PubMed  Google Scholar 

  24. Bertranou EG, Gonoraky SE, Otero AE. Martorell hypertensive arteriolar ulcer: outpatient outcome on 366 cases. Phlebologie. 2001;54:267–72; [Articles in French].

    Google Scholar 

  25. Baby D, Upadhyay M, Joseph MD, Asopa SJ, Choudhury BK, Rajguru JP, Gupta S. Calciphylaxis and its diagnosis: a review. J Family Med Prim Care. 2019;8(9):2763–7.

    PubMed  PubMed Central  Google Scholar 

  26. Schurgers LJ, Uitto J, Reutelingsperger CP. Vitamin K-dependent carboxylation of matrix Gla-protein: a crucial switch to control ectopic mineralization. Trends Mol Med. 2013;19:217–26.

    CAS  PubMed  Google Scholar 

  27. Bessueille L, Fakhry M, Hamade E, Badran B, Magne D. Glucose stimulates chondrocyte differentiation of vascular smooth muscle cells and calcification: a possible role for IL-1β. FEBS Lett. 2015;589(19 Pt B):2797–804.

    CAS  PubMed  Google Scholar 

  28. Chen NX, O’Neill K, Akl NK, Moe SM. Adipocyte induced arterial calcification is prevented with sodium thiosulfate. Biochem Biophys Res Commun. 2014;449:151–6.

    CAS  PubMed  Google Scholar 

  29. Kramann R, Brandenburg VM, Schurgers LJ, et al. Novel insights into osteogenesis and matrix remodelling associated with calcific uraemic arteriolopathy. Nephrol Dial Transplant. 2013;28(4):856–68.

    CAS  PubMed  Google Scholar 

  30. Luo G, Ducy P, McKee MD, et al. Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature. 1997;386:78–81.

    CAS  PubMed  Google Scholar 

  31. Cranenburg EC, Schurgers LJ, Uiterwijk HH, et al. Vitamin K intake and status are low in hemodialysis patients. Kidney Int. 2012;82(5):605–10.

    CAS  PubMed  Google Scholar 

  32. Brandenburg VM, Kramann R, Rothe H, et al. Calcific uraemic arteriolopathy (calciphylaxis): data from a large nationwide registry. Nephrol Dial Transplant. 2017;32:126–32.

    CAS  PubMed  Google Scholar 

  33. London GM, Guerin AP, Marchais SJ, Metivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transpl. 2003;18(9):1731–40.

    Google Scholar 

  34. London GM, Marty C, Marchais SJ, Guerin AP, Metivier F, de Vernejoul MC. Arterial calcifications and bone histomorphometry in end-stage renal disease. J Am Soc Nephrol. 2004;15(7):1943–51.

    PubMed  Google Scholar 

  35. Ishida M, Yao N, Yachiku S, Anzai T, Kobayashi T, Ishida H. Management of calcium, phosphorus and bone metabolism in dialysis patients using sevelamer hydrochloride and vitamin D therapy. Ther Apheresis Dial. 2005;9(Suppl 1):S16–21.

    CAS  Google Scholar 

  36. Moe SM, Chen NX. Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol. 2008;19(2):213–6.

    CAS  PubMed  Google Scholar 

  37. Hayden MR, Tyagi SC, Kolb L, Sowers JR, Khanna R. Vascular ossification-calcification in metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and calciphylaxis-calcific uremic arteriolopathy: the emerging role of sodium thiosulfate. Cardiovasc Diabetol. 2005;4:4.

    PubMed  PubMed Central  Google Scholar 

  38. Rogers NM, Teubner DJ, Coates PT. Calcific uremic arteriolopathy: advances in pathogenesis and treatment. Semin Dial. 2007;20(2):150–7.

    PubMed  Google Scholar 

  39. Wozney JM, Rosen V, Celeste AJ, Mitsock LM, Whitters MJ, Kriz RW, et al. Novel regulators of bone formation: molecular clones and activities. Science. 1988;242(4885):1528–34.

    CAS  PubMed  Google Scholar 

  40. Griethe W, Schmitt R, Jurgensen JS, Bachmann S, Eckardt KU, Schindler R. Bone morphogenic protein-4 expression in vascular lesions of calciphylaxis. J Nephrol. 2003;16(5):728–32.

    PubMed  Google Scholar 

  41. Feng JQ, Xing L, Zhang JH, Zhao M, Horn D, Chan J, et al. NF- kappaB specifically activates BMP-2 gene expression in growth plate chondrocytes in vivo and in a chondrocyte cell line in vitro. J Biol Chem. 2003;278(31):29130–5.

    CAS  PubMed  Google Scholar 

  42. Weenig RH. Pathogenesis of calciphylaxis: Hans Selye to nuclear factor kappa-B. J Am Acad Dermatol. 2008;58(3):458–71.

    PubMed  Google Scholar 

  43. Mikhaylova L, Malmquist J, Nurminskaya M. Regulation of in vitro vascular calcification by BMP4, VEGF and Wnt3a. Calcif Tissue Int. 2007;81(5):372–81.

    CAS  PubMed  Google Scholar 

  44. Yerram P, Chaudhary K. Calcific uremic arteriolopathy in end stage renal disease: pathophysiology and management. Ochsner J. 2014;14(3):380–5.

    PubMed  PubMed Central  Google Scholar 

  45. Schafer C, Heiss A, Schwarz A, Westenfeld R, Ketteler M, Floege J, et al. The serum protein alpha 2-Heremans-Schmid glycoprotein/fetuin-a is a systemically acting inhibitor of ectopic calcification. J Clin Investig. 2003;112(3):357–66.

    PubMed  PubMed Central  Google Scholar 

  46. Jeong HS, Dominguez AR. Calciphylaxis: controversies in pathogenesis, diagnosis and treatment. Am J Med Sci. 2016;351(2):217–27.

    PubMed  Google Scholar 

  47. Wilmer WA, Magro CM. Calciphylaxis: emerging concepts in prevention, diagnosis, and treatment. Semin Dial. 2002;15(3):172–86.

    PubMed  Google Scholar 

  48. Yu WY, Bhutani T, Kornik R, et al. Warfarin-associated nonuremic calciphylaxis. JAMA Dermatol. 2017;153:309–14.

    PubMed  PubMed Central  Google Scholar 

  49. Nigwekar SU, Bhan I, Turchin A, et al. Statin use and calcific uremic arteriolopathy: a matched case-control study. Am J Nephrol. 2013;37:325–32.

    CAS  PubMed  Google Scholar 

  50. Storan ER, O’Gorman SM, Murphy A, Laing M. Case report of calciphylaxis secondary to calcium and vitamin D3 supplementation. J Cutan Med Surg. 2017;21:162–3.

    PubMed  Google Scholar 

  51. Araki N, Misawa S, Shibuya K, et al. POEMS syndrome and calciphylaxis: an unrecognized cause of abnormal small vessel calcification. Orphanet J Rare Dis. 2016;11:35.

    PubMed  PubMed Central  Google Scholar 

  52. Monegal A, Peris P, Alsina M, et al. Development of multiorganic calciphylaxis during teriparatide, vitamin D, and calcium treatment. Osteoporos Int. 2016;27:2631–4.

    CAS  PubMed  Google Scholar 

  53. Davis JM. The relationship between obesity and calciphylaxis: a review of the literature. Ostomy Wound Manage. 2016;62:12–8.

    PubMed  Google Scholar 

  54. Nigwekar SU. An unusual case of nonhealing leg ulcer in a diabetic patient. Southern Med J. 2007;100:851–2.

    PubMed  Google Scholar 

  55. Nigwekar SU, Bloch DB, Nazarian RM, et al. Vitamin K-dependent carboxylation of matrix gla protein influences the risk of calciphylaxis. J Am Soc Nephrol. 2017;28:1717.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Hafner J. Calciphylaxis and Martorell hypertensive ischemic leg ulcer: same pattern - one pathophysiology. Dermatology. 2016;232(5):523–33.

    CAS  PubMed  Google Scholar 

  57. Ghosh T, Winchester DS, Davis MDP, El-Azhary R, Comfere NI. Early clinical presentations and progression of calciphylaxis. Int J Dermatol. 2017;56(8):856–61.

    PubMed  Google Scholar 

  58. 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.

    PubMed  Google Scholar 

  59. Handa SP, Strzelczak D. Uremic small artery disease: calciphylaxis with penis involvement. Clin Nephrol. 1998;50(4):258–61.

    CAS  PubMed  Google Scholar 

  60. Barbera V, Di Lullo L, Gorini A, Otranto G, Floccari F, Malaguti M, et al. Penile calciphylaxis in end stage renal disease. Case Rep Urol. 2013;2013:968916, 1.

    PubMed  PubMed Central  Google Scholar 

  61. Kazanji N, Falatko J, Neupane S, Reddy G. Calciphylaxis presenting as digital ischemia. Intern Emerg Med. 2015;10(4):529–30.

    PubMed  Google Scholar 

  62. Hafner J, Nobbe S, Partsch H, et al. Martorell hypertensive ischemic leg ulcer: a model of ischemic subcutaneous arteriolosclerosis. Arch Dermatol. 2010;146(9):961–8.

    PubMed  Google Scholar 

  63. Schnier BR, Sheps SG, Juergens JL. Hypertensive ischemic ulcer. Am J Cardiol. 1966;17(4):560–5.

    CAS  PubMed  Google Scholar 

  64. Polizzotto MN, Bryan T, Ashby MA, Martin P. Symptomatic management of calciphylaxis: a case series and review of the literature. J Pain Symptom Manag. 2006;32:186–90.

    Google Scholar 

  65. Gupta N, Haq KF, Mahajan S, et al. Gastrointestinal bleeding secondary to calciphylaxis. Am J Case Rep. 2015;16:818–22.

    PubMed  PubMed Central  Google Scholar 

  66. Brewster UC. Dermatological disease in patients with CKD. Am J Kidney Dis. 2008;51(2):331–44.

    PubMed  Google Scholar 

  67. Dauden E, Onate MJ. Calciphylaxis. Dermatol Clin. 2008;26(4):557–68. ix

    PubMed  Google Scholar 

  68. Brandenburg VM, Evenepoel P, Floege J, et al. Lack of evidence does not justify neglect: how can we address unmet medical needs in calciphylaxis? Nephrol Dial Transplant. 2016;31(8):1211–9.

    PubMed  Google Scholar 

  69. Stavros K, Motiwala R, Zhou L, Sejdiu F, Shin S. Calciphylaxis in a dialysis patient diagnosed by muscle biopsy. J Clin Neuromuscul Dis. 2014;15(3):108–11.

    PubMed  Google Scholar 

  70. Sreedhar A, Sheikh HA, Scagliotti CJ, Nair R. Advanced-stage calciphylaxis: think before you punch. Cleve Clin J Med. 2016;83(8):562–4.

    PubMed  Google Scholar 

  71. Ha CT, Nousari HC. Surgical pearl: double-trephine punch biopsy technique for sampling subcutaneous tissue. J Am Acad Dermatol. 2003;48:609–10.

    PubMed  Google Scholar 

  72. Fine A, Zacharias J. Calciphylaxis is usually non-ulcerating: risk factors, outcome and therapy. Kidney Int. 2002;61(6):2210–7.

    PubMed  Google Scholar 

  73. Chang JJ. Calciphylaxis: diagnosis, pathogenesis, and treatment. Adv Skin Wound Care. 2019;32(5):205–15.

    PubMed  Google Scholar 

  74. Burdorf BT. Calciphylaxis: the potential diagnostic role of radiologists. Radiol Case Rep. 2020;16(3):415–8.

    PubMed  PubMed Central  Google Scholar 

  75. Shmidt E, Murthy NS, Knudsen JM, Weenig RH, Jacobs MA, Starnes AM, et al. Net-like pattern of calcification on plain soft- tissue radiographs in patients with calciphylaxis. J Am Acad Dermatol. 2012;67(6):1296–301.

    PubMed  Google Scholar 

  76. Han MM, Pang J, Shinkai K, Franc B, Hawkins R, Aparici CM. Calciphylaxis and bone scintigraphy: case report with histological confirmation and review of the literature. Ann Nucl Med. 2007;21(4):235–8.

    PubMed  Google Scholar 

  77. Norris B, Vaysman V, Line BR. Bone scintigraphy of calciphylaxis: a syndrome of vascular calcification and skin necrosis. Clin Nucl Med. 2005;30(11):725–7.

    PubMed  Google Scholar 

  78. Martineau P, Pelletier-Galarneau M, Bazarjani S. The role of bone scintigraphy with single-photon emission computed tomography-computed tomography in the diagnosis and evaluation of calciphylaxis. World J Nuclear Med. 2017;16(2):172–4.

    Google Scholar 

  79. Paul S, Rabito CA, Vedak P, Nigwekar SU, Kroshinsky D. The role of bone scintigraphy in the diagnosis of calciphylaxis. JAMA Dermatol. 2017;153(1):101–3.

    PubMed  Google Scholar 

  80. Sowers KM, Hayden MR. Calcific uremic arteriolopathy: pathophysiology, reactive oxygen species and therapeutic approaches. Oxidative Med Cell Longev. 2010;3(2):109–21.

    Google Scholar 

  81. Dahl PR, Winkelmann RK, Connolly SM. The vascular calcification-cutaneous necrosis syndrome. J Am Acad Dermatol. 1995;33(1):53–8.

    CAS  PubMed  Google Scholar 

  82. Magro CM, Simman R, Jackson S. Calciphylaxis: a review. J Am Coll Certif Wound Spec. 2010;2(4):66–72.

    Google Scholar 

  83. Essary LR, Wick MR. Cutaneous calciphylaxis. An underrecognized clinicopathologic entity. Am J Clin Pathol. 2000;113(2):280–7.

    CAS  PubMed  Google Scholar 

  84. Zembowicz A, Navarro P, Walters S, Lyle SR, Moschella SL, Miller D. Subcutaneous thrombotic vasculopathy syndrome: an ominous condition reminiscent of calciphylaxis: calciphylaxis sine calcifications? Am J Dermatopathol. 2011;33(8):796–802.

    PubMed  Google Scholar 

  85. Vedvyas C, Winterfield LS, Vleugels RA. Calciphylaxis: a systematic review of existing and emerging therapies. J Am Acad Dermatol. 2012;67(6):e253–60.

    PubMed  Google Scholar 

  86. Erfurt-Berge C, Renner R. Management of patients with calciphylaxis: current perspectives. Chronic Wound Care Manag Res. 2019;6:109–15.

    Google Scholar 

  87. Sprague SM. Painful skin ulcers in a hemodialysis patient. Clin J Am Soc Nephrol. 2014;9:166–73.

    PubMed  Google Scholar 

  88. Torregrosa JV, Sánchez-Escuredo A, Barros X, et al. Clinical management of calcific uremic arteriolopathy before and after therapeutic inclusion of bisphosphonates. Clin Nephrol. 2015;83(4):231–4.

    CAS  PubMed  Google Scholar 

  89. Pasch A, Schaffner T, Huynh-Do U, Frey BM, Frey FJ, Farese S. Sodium thiosulfate prevents vascular calcifications in uremic rats. Kidney Int. 2008;74(11):1444–53.

    CAS  PubMed  Google Scholar 

  90. Nigwekar SU, Brunelli SM, Meade D, Wang W, Hymes J, Lacson E Jr. Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol. 2013;8:1162–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  91. Baldwin C, Farah M, Leung M, et al. Multi-intervention management of calciphylaxis: a report of 7 cases. Am J Kidney Dis. 2011;58(6):988–91.

    PubMed  Google Scholar 

  92. Martin R. Mysterious calciphylaxis: wounds with eschar—to debride or not to debride? Ostomy Wound Manage. 2004;50(4):64–6, 68–70; discussion 71.

    PubMed  Google Scholar 

  93. Bechara FG, Altmeyer P, Kreuter A. Should we perform surgical debridement in calciphylaxis? Dermatol Surg. 2009;35(3):554–5.

    CAS  PubMed  Google Scholar 

  94. Wollina U, Helm C, Hansel G, et al. Deep ulcer shaving combined with split-skin transplantation in distal calciphylaxis. Int J Lower Extremity Wounds. 2008;7(2):102–7.

    Google Scholar 

  95. Basile C, Montanaro A, Masi M, Pati G, De Maio P, Gismondi A. Hyperbaric oxygen therapy for calcific uremic arteriolopathy: a case series. J Nephrol. 2002;15(6):676–80.

    PubMed  Google Scholar 

  96. Podymow T, Wherrett C, Burns KD. Hyperbaric oxygen in the treatment of calciphylaxis: a case series. Nephrol Dial Transplant. 2001;16(11):2176–80.

    CAS  PubMed  Google Scholar 

  97. Cole W, Yoder CM, Coe S. The use of topical oxygen therapy to treat a Calciphylaxis wound during a global pandemic: a case report. Wounds. 2020;32(11):294–8.

    PubMed  Google Scholar 

  98. Sayadi LR, Banyard DA, Ziegler ME, Obagi Z, Prussak J, Klopfer MJ, Evans GR, Widgerow AD. Topical oxygen therapy & micro/nanobubbles: a new modality for tissue oxygen delivery. Int Wound J. 2018;15(3):363–74.

    PubMed  PubMed Central  Google Scholar 

  99. Tittelbach J, Graefe T, Wollina U. Painful ulcers in calciphylaxis—combined treatment with maggot therapy and oral pentoxyfillin. J Dermatolog Treat. 2001;12(4):211–4.

    CAS  PubMed  Google Scholar 

  100. Picazo M, Bover J, de la Fuente J, Sans R, Cuxart M, Matas M. Sterile maggots as adjuvant procedure for local treatment in a patient with proximal calciphylaxis. Nefrologia. 2005;25(5):559–62.

    CAS  PubMed  Google Scholar 

  101. Davison SN. The prevalence and management of chronic pain in end-stage renal disease. J Palliat Med. 2007;10(6):1277–87.

    PubMed  Google Scholar 

  102. Cleary JF. Incident pain. Palliat Med. 2005;19(1):1e2.14.

    Google Scholar 

  103. Good P, Tullio F, Jackson K, Goodchild C, Ashby M. Prospective audit of short term concurrent ketamine, opioid and anti-inflammatory (‘triple-agent’) therapy for episodes of acute on chronic pain. Intern Med J. 2005;35:39e44.

    Google Scholar 

  104. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Manag. 2004;28(5):497–504.

    CAS  Google Scholar 

  105. Santos PW, He J, Tuffaha A, Wetmore JB. Clinical characteristics and risk factors associated with mortality in calcific uremic arteriolopathy. Int Urol Nephrol. 2017;49(12):2247–56.

    CAS  PubMed  Google Scholar 

  106. JT MC, El-Azhary RA, Patzelt MT, et al. Survival, risk factors, and effect of treatment in 101 patients with calciphylaxis. Mayo Clin Proc. 2016;91:1384–94.

    Google Scholar 

  107. Riemer CA, El-Azhary RA, Wu KL, et al. Underreported use of palliative care and patient-reported outcome measures to address reduced quality of life in patients with calciphylaxis: a systematic review. Br J Dermatol. 2017;177:1510–8.

    CAS  PubMed  Google Scholar 

  108. Lal G, Nowell AG, Liao J, Sugg SL, Weigel RJ, Howe JR. Determinants of survival in patients with calciphylaxis: a multi-variate analysis. Surgery. 2009;146(6):1028–34.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Michelucci, A., Romanelli, P., Dini, V., Romanelli, M. (2023). Ulcers Caused by Calciphylaxis. In: Khanna, A.K., Tiwary, S.K. (eds) Uncommon Ulcers of the Extremities. Springer, Singapore. https://doi.org/10.1007/978-981-99-1782-2_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-1782-2_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-1781-5

  • Online ISBN: 978-981-99-1782-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics