A Case of Calciphylaxis Without CKD or ESRD
A patient experienced painful skin ulcers despite having normal renal function.
ORLANDO, Fla. — Calciphylaxis or calcific uremic arteriolopathy is characterized by vascular calcification and necrotic skin lesions. It develops in only a tiny fraction of chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients, but it is often fatal. What exactly triggers the condition remains a mystery. Now researchers at the National Kidney Foundation Spring Clinical Meetings discuss an interesting case of a calciphylaxis patient without underlying kidney disease.
A 54-year old, obese Caucasian man with hypertension and diabetes presented with hypotension (80/40 mm Hg) and a serum creatinine level of 3 mg/dL, Arun Rajasekaran, MD, and colleagues from the University of Central Florida College of Medicine in Orlando, Florida, described. With fluid resuscitation, the patient's acute kidney injury eased and his serum creatinine levels returned to a baseline of 1.1 mg/dL within 2 days. Despite these improvements, his blood urea nitrogen (BUN) remained abnormally high at 72 mg/dL. A check of the man's estimated glomerular filtration rate, intact/ionized serum calcium levels, and intact parathyroid hormone levels revealed nothing out of the ordinary. His albumin levels were 3.9 g/dL, magnesium 1.8 mEq/L, prothrombin time 13.3, and international normalized ratio 1.0.
After 2 days, necrotic skin lesions appeared on the patient's upper left arm and both legs. Biopsy results indicated calcification in medium-sized arteries without vasculitis, suggesting calciphylaxis. After surgical debridement and skin grafting, the usual calciphylaxis treatments, the lesions completely healed.
“Of interest was our patient's persistently elevated BUN, despite aggressive fluid hydration,” Dr Rajasekaran and colleagues stated. “Perhaps this can be used as a marker for calciphylaxis in patients with otherwise normal renal function.”
See more coverage from the National Kidney Foundation Spring Clinical meeting.
Rajasekaran A, Ashton R, Patni H, Kar P. Calciphylaxis in the absence of chronic kidney disease or end-stage renal disease. Poster presented at the National Kidney Foundation's 2017 Spring Clinical Meetings in Orlando, Florida, April 18-22, 2017. Poster 256.