Calciphylaxis: Difference between revisions
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==Background== | ==Background== | ||
*Most commonly HD/ESRD patients (1% of ESRD) | *Most commonly HD/ESRD patients (1% of ESRD) | ||
**Seen almost exclusively in patients with Stage 5 chronic kidney disease | |||
*No available data in general population (non-uremic calciphylaxis) | *No available data in general population (non-uremic calciphylaxis) | ||
*Calcium and phosphate levels rise beyond solubility and precipitate in arteries | *Calcium and phosphate levels rise beyond solubility and precipitate in arteries | ||
Revision as of 16:55, 21 November 2014
Background
- Most commonly HD/ESRD patients (1% of ESRD)
- Seen almost exclusively in patients with Stage 5 chronic kidney disease
- No available data in general population (non-uremic calciphylaxis)
- Calcium and phosphate levels rise beyond solubility and precipitate in arteries
- May be increasing due to widespread IV vitamin D
- Mortality as high as 60-80%; sepsis from necrotic skin lesions
Features
- Very painful lesions develop suddenly and progress rapidly
- Dermatolgic appearances:
- Livedo reticularis
- Stellate purpura
- Usually LEs, hands, or torso
Differential Diagnosis
- Brown recluse spider bite
- Bullous Pemphigoid
- Cellulitis, necrotizing fasciitis
- Erythema Nodosum
- Vasculitis
- Venous ulcers
- Hypercalcemia
- Hyperphosphatemia
Diagnosis
Labs
- Serum PTH level
- CBC, CMP, phosphate, coags
- Inpatient - hepatitis panel, cryofibrinogen level, lipase, ESR, CRP, ANA, ANCA
Imaging
- Plain radiographs - arborization of vascular calcification within dermis and subQ tissues
Management
- Medical