Calcific uremic arteriolopathy is an uncommon cutaneous ischemic necrotizing disease, most commonly associated with renal disease and hyperparathyroidism, bearing a high mortality rate.
Objective and Method:
A case of a 57-year-old female renal patient with hyperparathyroidism who was successfully treated with combined paricalcitol and cinacalcet systemically, while autologous growth factors were locally applied, is herein presented.
Result and Conclusion:
The combination of cinacalcet and paricalcitol is a reliable alternative to parathyroidectomy in patients with calcific uremic arteriolopathy and hyperparathyroidism. Meticulous débridement of necrotic tissues is essential and application of autologous growth factors promotes healing.
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References
1.
CoatesTKirklandGSDymockRB. Cutaneous necrosis from calcific uremic arteriolopathy. Am J Kidney Dis1998;32:384–91, doi:10.1053/ajkd.1998.v32.pm9740153.
2.
RogersNNTeubnerDJOCoatesTH. Calcific uremic arteriolopathy: advances in pathogenesis and treatment. Semin Dial2007;20:150–7, doi:10.1111/j.1525-139X.2007.00263.x.
3.
CanellaGMessaP. Therapy of secondary hyperparathyroidism to date: vitamin D analogs, calcimimetics or both?J Nephrol2006;19:399–402.
4.
VelascoNMacGregorMSInnesAMackayIG. Successful treatment of calciphylaxis with cinacalcet. An alternative to parathyroidectomy? Nephrol Dial Transplant2006;21:1999–2004, doi:10.1093/ndt/gfl114.
5.
VargemezisVLiakopoulosVKrikiP. Pivotal role of paricalcitol in the treatment of calcific uremic arteriolopathy in the presence of parathyroid adenoma. Am J Kidney Dis2009;55:144–7, doi:10.1053/j.ajkd.2009.03.015.
6.
AndressD. Nonclassical aspects of differential vitamin D receptor activation. Drugs2007;67:1999–2012, doi:10.2165/00003495-200767140-00003.
7.
AlborgiPPatelNAPetersonC. Paricalcitol reduces albuminuria and inflammation in chronic kidney disease. A randomized double-blind pilot trial. Hypertension2008;52:249–55, doi:10.1161/HYPERTENSIONAHA.108.113159.
8.
RedmanRMisitaCPStaffordDW. Warfarin-associated calciphylaxis in a patient without renal failure or hyperparathyroidism. Investigation of matrix GLA protein. Blood2005;106:3969A.
9.
ThodisEKrikiPKakagiaD. Rigorous Vibrio vulnificus soft tissue infection of the lower leg in a renal transplant patient managed by vacuum therapy and autologous growth factors. J Cutan Med Surg2009;13:209–14.
10.
AtriSCMisraJBishtDMisraK. Use of homologous platelet factors in achieving total healing of recalcitrant skin ulcers. Surgery1990;108:508–12.
