Two cases of calciphylaxis treated by parathyroidectomy

Importance of increased bone formation

H. Maeda, M. Tokumoto, H. Yotsueda, M. Taniguchi, K. Tsuruya, H. Hirakata, M. Iida

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Calciphylaxis (calcific uremic arteriolopathy) is a poorly understood and highly morbid syndrome of both vascular calcification and skin necrosis. The main histopathological finding is calcium deposits within arteriolar and small vessel walls, showing endovascular fibrosis associated with fat necrosis. The therapeutic strategy is to normalize the high calcium-phosphate products (Ca × P). When calciphylaxis is complicated with advanced renal hyperparathyroidism (HPT), parathyroidectomy (PTX) should be performed promptly. However, for patients with low PTH level, calciphylaxis is unresponsive to PTX, and such an approach may worsen hyperphosphatemia and hypercalcemia. We report two patients with calciphylaxis confirmed by skin biopsy. PTX was performed in both patients based on high PTH levels. PTH and Ca × P level decreased in both patients post PTX. In Case 1, the skin ulcers gradually improved and almost disappeared after PTX. However, in Case 2, new ulcers appeared after PTX. In Case 1, alkaline phosphatase (ALP) after PTX was approximately twice its level before surgery and PTX resulted in normalization of uptake on bone scintigraphy. However, no rise in ALP was noted in Case 2, probably due to long-term use of aluminum, which prevented bone formation. These findings suggest that differences in the extent of bone formation explain the different response in post-PTX ulcer healing.

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalClinical Nephrology
Volume67
Issue number6
StatePublished - Jun 2007

Fingerprint

Calciphylaxis
Parathyroidectomy
Osteogenesis
Ulcer
Alkaline Phosphatase
Fat Necrosis
Skin Ulcer
Hyperphosphatemia
Vascular Calcification
Skin
Hyperparathyroidism
Hypercalcemia
Aluminum
Radionuclide Imaging
Fibrosis
Necrosis
Calcium
Kidney
Biopsy
Bone and Bones

Keywords

  • Bone formation
  • Bone scintigraphy
  • Calcific uremic arteriology
  • Calciphylaxis
  • Parathyroidectomy

ASJC Scopus subject areas

  • Nephrology

Cite this

Maeda, H., Tokumoto, M., Yotsueda, H., Taniguchi, M., Tsuruya, K., Hirakata, H., & Iida, M. (2007). Two cases of calciphylaxis treated by parathyroidectomy: Importance of increased bone formation. Clinical Nephrology, 67(6), 397-402.

Two cases of calciphylaxis treated by parathyroidectomy : Importance of increased bone formation. / Maeda, H.; Tokumoto, M.; Yotsueda, H.; Taniguchi, M.; Tsuruya, K.; Hirakata, H.; Iida, M.

In: Clinical Nephrology, Vol. 67, No. 6, 06.2007, p. 397-402.

Research output: Contribution to journalArticle

Maeda, H, Tokumoto, M, Yotsueda, H, Taniguchi, M, Tsuruya, K, Hirakata, H & Iida, M 2007, 'Two cases of calciphylaxis treated by parathyroidectomy: Importance of increased bone formation', Clinical Nephrology, vol. 67, no. 6, pp. 397-402.
Maeda H, Tokumoto M, Yotsueda H, Taniguchi M, Tsuruya K, Hirakata H et al. Two cases of calciphylaxis treated by parathyroidectomy: Importance of increased bone formation. Clinical Nephrology. 2007 Jun;67(6):397-402.
Maeda, H. ; Tokumoto, M. ; Yotsueda, H. ; Taniguchi, M. ; Tsuruya, K. ; Hirakata, H. ; Iida, M. / Two cases of calciphylaxis treated by parathyroidectomy : Importance of increased bone formation. In: Clinical Nephrology. 2007 ; Vol. 67, No. 6. pp. 397-402.
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