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Calciphylaxis: A Rare Complication of Patients Who Required Parathyroidectomy for Advanced Renal Hyperparathyroidism

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Abstract

Calciphylaxis is a relatively rare but life-threatening complication in uremic patients. Clinical findings and prognosis were evaluated in six patients who developed calciphylaxis from a group of 1499 patients who underwent parathyroidectomy (PTx) for advanced renal hyperparathyroidism (HPT) in our department from July 1972 to July 2003. The frequency of calciphylaxis was 0.40% (6/1499). Two patients were women and four were men. The mean age was 50.5 years, and the mean duration of hemodialysis (HD) treatment was 14.0 years. In five of six patients, calciphylaxis was classified as distal type; in one case, as proximal type. In three patients, calciphylaxis was diagnosed at the time for PTx. In two patients, calciphylaxis was identified after PTx, although the serum parathyroid hormone (PTH) level was within the appropriate range for dialysis patients. In two patients, calciphylaxis improved after PTx, but two patients required leg and toe amputations after PTx. In one patient with the proximal type of calciphylaxis, the condition occurred when a high PTH level recurred after the initial PTx. The patient died as a result of a serious infection due to uncontrollable skin ulcers. Calciphylaxis is a rare complication in patients who require PTx for renal HPT. Especially the proximal type has a poor prognosis. High levels of the Ca × P product and/or PTH are risk factors. Therefore, this syndrome should be kept in mind and attention should be paid to reduce risk factors. It is important that PTx being performed at the right time in patients with advanced renal HPT refractory to medical treatment.

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References

  1. HJ Adrogue MR Frazier B Zeluff et al. (1981) ArticleTitleSystemic calciphylaxis revisited Am. J. Nephrol. 1 177–183 Occurrence Handle7349051

    PubMed  Google Scholar 

  2. YL Chan JF Mahony JJ Turner et al. (1983) ArticleTitleThe vascular lesions associated with skin necrosis in renal disease Br. J. Dermatol 109 85–95 Occurrence Handle6344907

    PubMed  Google Scholar 

  3. CN Ross MJD Cassidy M Thompson et al. (1991) ArticleTitleProximal cutaneous necrosis associated with small vessel calcification in renal failure Q. J. Med. New Ser. 79:443JI 50

    Google Scholar 

  4. MN Budisavljevic D Cheek DW. Ploth (1996) ArticleTitleCalciphylaxis in chronic renal failure J. Am. Soc. Nephrol. 7 978–982 Occurrence Handle8829111

    PubMed  Google Scholar 

  5. T Coates GS Kirkland RB Dymock et al. (1998) ArticleTitleCutaneous necrosis from calcific uremic arteriolopathy Am. J. Kidney Dis. 32 384–391 Occurrence Handle9740153

    PubMed  Google Scholar 

  6. F. Llach (1998) ArticleTitleCalcific uremic arteriolopathy (calciphylaxis): an evolving entity? Am J. Kidney Dis. 32 384–391 Occurrence Handle9740153

    PubMed  Google Scholar 

  7. Y. Tominaga (1999) ArticleTitleSurgical management of secondary hyperparathyroidism in urema Am. J. Med. Sci. 317 390–397 Occurrence Handle10.1097/00000441-199906000-00007 Occurrence Handle10372839

    Article  PubMed  Google Scholar 

  8. J Hafner G Keusch C Wahl et al. (1995) ArticleTitleUremic small-artery diease with medial calcification and intimal hyperplasia (so-called calciphylaxis): a complication of chronic renal failure and benefit from parathyroidectomy J. Am. Acad. Dermatol. 33 954–962 Occurrence Handle10.1016/0190-9622(95)90286-4 Occurrence Handle7490365

    Article  PubMed  Google Scholar 

  9. M Angelis LL Wong SA Myers et al. (1997) ArticleTitleCalciphylaxis in patients on hemodialysis: a prevalence study Surgery 122 1083–1090 Occurrence Handle10.1016/S0039-6060(97)90212-9 Occurrence Handle9426423

    Article  PubMed  Google Scholar 

  10. A Levin RL Mehta MB. Goldstein (1993) ArticleTitleMathematical formulation to help identify the patient at risk of ischemic tissue necrosis: a potentially lethal complication of chronic renal failure Am. J. Nephrol. 13 448–453 Occurrence Handle8141179

    PubMed  Google Scholar 

  11. H. Selye (1962) Calciphylaxis University of Chicago Press Chicago 1–16

    Google Scholar 

  12. K McAuley F Devereux R. Walker (1997) ArticleTitleCalciphylaxis in two non-compliant patients with end-stage renal failure Nephrol. Dial. Transplant. 12 1061–1063 Occurrence Handle10.1093/ndt/12.5.1061 Occurrence Handle9175074

    Article  PubMed  Google Scholar 

  13. P Patetsios M Bernstein S Kim et al. (2000) ArticleTitleSevere necrotizing mastopathy caused by calciphylaxis alleviated by total parathyroidectomy Am. Surg. 66 1056–1058 Occurrence Handle11090018

    PubMed  Google Scholar 

  14. S Asirvatham C Sebastian CA Sivaram et al. (1998) ArticleTitleAortic valve involvement in calciphylaxis: uremic small artery disease with medial calcification and intimal hyperplasia Am. J. Kidney Dis. 32 499–502 Occurrence Handle9740169

    PubMed  Google Scholar 

  15. AJ Bleyer M Choi B Igwemezie et al. (1998) ArticleTitleA case control study of proximal calciphylaxis Am. J. Kidney Dis. 32 376–383 Occurrence Handle9740152

    PubMed  Google Scholar 

  16. S Sankarasubbaiyan G Scott JL. Holley (1998) ArticleTitleCryofibrinogenemia: an addition to the differential diagnosis of calciphylaxis in end-stage renal disease Am. J. Kidney Dis. 32 494–98 Occurrence Handle9740168

    PubMed  Google Scholar 

  17. RL Mehta G Scott JA Sloand et al. (1990) ArticleTitleSkin necrosis associated with acquired protein C deficiency in patients with renal failure and calciphylaxis Am. J. Med. 88 252–257 Occurrence Handle10.1016/0002-9343(90)90150-C Occurrence Handle2309740

    Article  PubMed  Google Scholar 

  18. C Canavese F Cesarani C Stratta et al. (2000) ArticleTitleDramatic worsening of vascular calcification after kidney transplantation in spite of early parathyroidectomy Clin. Nephrol. 4 487–491

    Google Scholar 

  19. GM Chertow SK Burke P. Raggi (2002) ArticleTitlefor the Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialylysis patients Kidney Int. 62 245–252 Occurrence Handle10.1046/j.1523-1755.2002.00434.x Occurrence Handle12081584

    Article  PubMed  Google Scholar 

  20. T Akizawa E Kinugasa T Akiba et al. (1997) ArticleTitleIncidence and clinical characteristics of hypoparathyroidism in dialysis patients Kidney Int. S. 62 IssueIDSuppl S72–S74

    Google Scholar 

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Acknowledgments

We thank Professor Henry Johasson, Department of Surgery, Uppsala University Hospital, Sweden, for his kind advice and valuable discussions.

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Authors and Affiliations

  1. Department of Surgery, Renal Center, Nagoya Second Red Cross Hospital, Nagoya University, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan

    Susumu Matstusoka M.D., Yoshihiro Tominaga M.D., Nobuaki Uno M.D., Norihiko Goto M.D., Tetsuhiko Sato M.D., Akio Katayama M.D., Toshihito Haba M.D. & Kazuharu Uchida M.D.

  2. Department of Dermatology, Nagoya Second Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan

    Keiko Kobayashi M.D.

  3. Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8650, Japan

    Akimasa Nakao M.D.

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  1. Susumu Matstusoka M.D.
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  2. Yoshihiro Tominaga M.D.
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  3. Nobuaki Uno M.D.
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  4. Norihiko Goto M.D.
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  5. Tetsuhiko Sato M.D.
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  6. Akio Katayama M.D.
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  7. Toshihito Haba M.D.
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  8. Kazuharu Uchida M.D.
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  9. Keiko Kobayashi M.D.
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  10. Akimasa Nakao M.D.
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Correspondence to Susumu Matstusoka M.D..

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Matstusoka, S., Tominaga, Y., Uno, N. et al. Calciphylaxis: A Rare Complication of Patients Who Required Parathyroidectomy for Advanced Renal Hyperparathyroidism. World J. Surg. 29, 632–635 (2005). https://doi.org/10.1007/s00268-005-7514-9

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  • DOI: https://doi.org/10.1007/s00268-005-7514-9

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