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1.
Ann R Coll Surg Engl ; 102(2): e36-e38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31530167

RESUMO

Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.


Assuntos
Angioplastia/métodos , Calciofilaxia/terapia , Tratamento Conservador/métodos , Doenças do Pênis/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Bandagens , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Artéria Femoral/cirurgia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/irrigação sanguínea , Pênis/patologia , Diálise Renal/efeitos adversos , Resultado do Tratamento
2.
G Ital Nefrol ; 36(5)2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31580546

RESUMO

Calcific uremic arteriolopathy (CUA) is a highly morbid condition usually found in ESRD patients that has rarely been reported after renal transplantation and renal function restoration. Furthermore, little is known about the optimal management of CUA in this setting. Herein, we report on the clinical case of AB, a 70-year-old woman who developed CUA after renal transplantation and renal function restoration. However, other risk factors for CUA such as diabetes and warfarin treatment, due to mechanical aortic valve implantation, were present. Thirty-eight months after renal transplantation she developed erythema and livedo reticularis in both legs and a gradually enlarging skin ulcer in the right leg. A skin biopsy of the ulcer showed features compatible with the CUA, such as sub-intimal calcification and luminal obstruction of the small dermal arterioles, tissue ischemia and signs of adipocytes degeneration. A multidisciplinary approach was adopted, including medical and non-medical treatments such as surgical debridement and vacuum-assisted closure therapy. Medical treatments included a five weeks course of once a week intravenous infusion of pamidronate and intravenous sodium thiosulfate (STS) at increasing doses. Four months after beginning the therapy with STS, a complete healing of the ulcer on the right leg and the disappearance of the livedo reticularis on the left leg was noted. In conclusion, although rare CUA may develop also in renal transplanted patients, a timely and combined therapeutic approach is essential for its resolutive treatment. Sodium thiosulfate therapy has proven to be effective and tolerated.


Assuntos
Calciofilaxia/terapia , Transplante de Rim/efeitos adversos , Úlcera da Perna/terapia , Doenças Raras/terapia , Idoso , Anticoagulantes/uso terapêutico , Conservadores da Densidade Óssea/administração & dosagem , Calciofilaxia/etiologia , Quelantes/administração & dosagem , Terapia Combinada/métodos , Diabetes Mellitus , Feminino , Humanos , Úlcera da Perna/etiologia , Livedo Reticular/etiologia , Livedo Reticular/terapia , Pamidronato/administração & dosagem , Doenças Raras/etiologia , Fatores de Risco , Tiossulfatos/administração & dosagem , Varfarina/uso terapêutico
3.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471365

RESUMO

A 70-year-old man with history of metastatic well-differentiated neuroendocrine carcinoma was presented to the hospital with a painful left lower extremity ulcer which started around 3 months prior to presentation. He was treated with antibiotics for cellulitis on multiple occasions with no improvement in his symptoms. On initial laboratory evaluation, he was found to have acute kidney injury and a normal calcium level. The patient underwent a skin biopsy and was found to have cellulitis and calciphylaxis of small-sized and medium-sized vessels. Since the patient did not have any underlying risk factors of calciphylaxis, the most likely cause of his calciphylaxis was thought to be his underlying malignancy. Physicians should keep this differential in mind while treating non-healing ulcers in such patients since they are at higher risk of superimposed infections and usually require aggressive wound care.


Assuntos
Lesão Renal Aguda/etiologia , Calciofilaxia/etiologia , Carcinoma Neuroendócrino/complicações , Úlcera da Perna/etiologia , Idoso , Humanos , Masculino
4.
Am J Case Rep ; 20: 1170-1174, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395848

RESUMO

BACKGROUND Calciphylaxis is a rare and fatal systemic disease which most commonly occurs in patients with end-stage renal disease. It is a poorly understood vascular calcification with unclear pathology that leads to vascular compromise due to vascular occlusion with endoluminal calcification. CASE REPORT We report a case of a 61-year-old male with chronic kidney disease stage 5 who developed calciphylaxis. The patient was diagnosed with dry gangrene of the second and third digits of the right hand and second, third, and fourth phalanges of the left hand. Despite medical therapy and local wound care, the lesions progressively worsened with time. The patient was found to have secondary hyperparathyroidism (parathyroid hormone was 1028 pg/mL) and underwent subtotal parathyroidectomy. In our patient, the skin lesions due to calciphylaxis completely resolved over the course of 12 months. CONCLUSIONS Parathyroidectomy has been associated with clinical benefit in patients with calciphylaxis. Clinicians should consider parathyroidectomy in the setting of high parathyroid hormone and calciphylaxis. Although parathyroidectomy is an effective treatment option for calciphylaxis it is not a definitive treatment and calciphylaxis can occur, though rarely, even after parathyroidectomy. There is a need to do further studies in order to confirm the efficacy of parathyroidectomy.


Assuntos
Calciofilaxia/etiologia , Dedos/patologia , Gangrena/etiologia , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia , Insuficiência Renal Crônica/complicações , Calciofilaxia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Adv Skin Wound Care ; 32(5): 205-215, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31008757

RESUMO

GENERAL PURPOSE: To provide information on the pathogenesis, clinical features, diagnosis, and treatment of calciphylaxis. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Recognize the pathogenesis and clinical features of and risk factors for calciphylaxis.2. Explain the diagnosis and management of a patient with calciphylaxis. ABSTRACT: Calciphylaxis is a cutaneous ischemic infarct caused by total occlusion of blood vessels initiated by vascular calcification. Until recently, treatments have been limited to controlling its risk factors and optimizing wound care. However, recent advances in clinical understanding of the mechanism of calciphylaxis have identified promising potential therapeutic targets. This article is a narrative review summarizing the clinical features, diagnosis, pathogenesis, and treatment of calciphylaxis.


Assuntos
Calciofilaxia , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Calciofilaxia/patologia , Calciofilaxia/terapia , Quelantes/uso terapêutico , Humanos , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Manejo da Dor , Diálise Renal , Fatores de Risco , Tiossulfatos/uso terapêutico , Trombose , Calcificação Vascular/prevenção & controle , Calcificação Vascular/terapia , Vitamina K/uso terapêutico , Deficiência de Vitamina K/complicações , Cicatrização
7.
Dermatology ; 235(2): 120-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30605905

RESUMO

BACKGROUND: Calciphylaxis (CPX) is a rare and life-threatening disease characterized by vascular calcification and development of painful and necrotizing skin lesions with a challenging management. Mechanisms of CPX are complex and include an imbalance between vascular calcification promoters and inhibitors, and frequently vitamin K deficiency. OBJECTIVES: To describe the various presentations and identify predictive factors of death in patients with CPX. METHODS: In this multicenter retrospective study, we included 71 CPX patients followed in South-West France (n = 26) and in French Polynesia (n = 45), and who all received sodium thiosulfate (25 g thrice weekly for a median of 61 days). RESULTS: Characteristics at presentation significantly differed between metropolitan and Polynesian French patients. Polynesians were less frequently on regular dialysis at the onset of CPX, had a higher incidence of diabetes mellitus and obesity, more disturbances of calcium-phosphorus metabolism, and received vitamin K antagonists less frequently than patients from South-West France. Despite intensive management, the 1-year mortality rate was 66% and median time to death was 200 days (IQR, 40; 514). The number of body areas involved (i.e., three: OR 2.70 [1.09; 6.65], p = 0.031; four: OR 8.79 [1.54; 50.29], p = 0.015) was the only predictive factor for death, whereas application of topical cerium nitrate-silver sulfadiazine was protective (OR 0.44 [0.20; 0.99], p = 0.046). Surgical debridement, hyperbaric oxygenation therapy, and geographical origin were not associated with overall outcomes. CONCLUSIONS: Cerium nitrate may lead to vascular decalcification and chelation of reactive oxygen species, and prevent infection. Cerium nitrate-silver sulfadiazine was associated with better outcomes and should be tested in a prospective comparative trial in CPX patients.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Calciofilaxia/terapia , Cério/uso terapêutico , Sulfadiazina de Prata/uso terapêutico , Dermatopatias Vasculares/tratamento farmacológico , Administração Cutânea , Idoso , Anti-Infecciosos Locais/administração & dosagem , Calciofilaxia/etiologia , Cério/administração & dosagem , Quelantes , Combinação de Medicamentos , Feminino , França , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Polinésia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Sulfadiazina de Prata/administração & dosagem , Dermatopatias Vasculares/etiologia , Taxa de Sobrevida , Tiossulfatos/uso terapêutico , Resultado do Tratamento
8.
Burns ; 45(1): 241-246, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30322738

RESUMO

Calciphylaxis is a rare, necrotizing skin disorder usually associated with kidney disease, but also caused by many other systemic illnesses. This disease is associated with mortality rates as high as 80% at 1year. We present the demographic and clinical data of nine patients with calciphylaxis treated at our burn center over a 10year period. We review the literature on the clinical presentation, pathophysiology, diagnosis and treatment of this rare disease. We propose that these patients be treated similar to patients with thermal burn injury; meaning intensive wound care, surgical management, critical care and physical therapy. Burn centers are uniquely capable of caring for these incredibly complex patients due to their experience in managing patients with extensive skin and soft tissue defects, wounds and diseases.


Assuntos
Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Unidades de Queimados , Calciofilaxia/terapia , Desbridamento , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Calciofilaxia/etiologia , Gerenciamento Clínico , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
QJM ; 112(1): 29-34, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30304522

RESUMO

Calciphylaxis is a disease of significant morbidity and mortality, predominantly affecting dialysis patients. The term 'calciphylaxis' was coined by Seyle et al. in 1961 to describe calcium deposition in the skin and subcutaneous soft tissue of uremic rats in response to 'triggers' (e.g. trauma, metallic salts) after exposure to 'sensitizing agents' (e.g. vitamin D and parathyroid hormone). In humans, calciphylaxis, however, is not a disorder of induced hypersensitivity. Instead, it is a disorder of cutaneous microvascular occlusion caused by thrombosis and calcification. Progressive, excruciatingly painful, non-healing wounds develop in these patients, pre-disposing them to high risk of sepsis and death. Calciphylaxis has no approved therapies. Increased awareness and research in this field have facilitated identification of risk factors and causation pathways. Development of therapeutic options and wound care management, however, are still at a nascent stage. Certain therapies have shown a promise that needs evaluation in prospective clinical trials. It is hoped that ongoing research will help us better understand the pathogenesis of this complex disease and develop efficacious treatment options. In this review, we outline the components involved in calciphylaxis diagnosis and treatment.


Assuntos
Calciofilaxia/diagnóstico , Calciofilaxia/terapia , Falência Renal Crônica/complicações , Calcificação Vascular/diagnóstico , Calcificação Vascular/terapia , Calciofilaxia/etiologia , Humanos , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Fatores de Risco , Calcificação Vascular/etiologia
11.
Nefrología (Madrid) ; 38(6): 579-586, nov.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178387

RESUMO

La calcifilaxis, también denominada arteriolopatía urémica calcificante, es un síndrome raro que causa típicamente necrosis cutánea y que afecta principalmente a los pacientes en diálisis. La patogénesis es multifactorial y depende de la suma de todos los factores que producen calcificaciones ectópicas en el paciente con enfermedad renal crónica, como las alteraciones del metabolismo calcio-fósforo, el hiper o el hipoparatiroidismo, la diabetes, la obesidad, la inflamación sistémica y el uso de inhibidores de vitamina K, entre otros. Desde un punto de vista clínico, la calcifilaxis puede evolucionar desde una púrpura dolorosa hasta extensas áreas de necrosis cutánea que pueden sobreinfectarse y llegar a causar el fallecimiento del paciente por sepsis. El tratamiento se basa fundamentalmente en el manejo de las heridas, la eliminación de todos los elementos que puedan precipitar la calcificación ectópica y el uso de agentes inhibidores del proceso de calcificación


Calciphylaxis, also known as calcific uraemic arteriolopathy, is a rare syndrome that typically causes skin necrosis and usually affects dialysis patients. Its pathogenesis is multifactorial and is the consequence of many factors causing ectopic calcifications in patients with chronic kidney disease, such as calcium-phosphate metabolism disorders, hyper- or hypo-parathyroidism, diabetes, obesity, systemic inflammation and the use of vitamin K antagonists, among others. From a clinical point of view, calciphylaxis may progress from painful purpura to extensive areas of skin necrosis that can potentially lead to superinfection and the death of the patient due to sepsis. Treatment is primarily based on managing the wounds, eliminating all the possible precipitating factors of ectopic calcification and administering agents which are capable of inhibiting the process of calcification


Assuntos
Humanos , Insuficiência Renal Crônica/complicações , Calciofilaxia/etiologia , Insuficiência Renal Crônica/terapia , Diagnóstico Diferencial , Calciofilaxia/terapia , Fatores de Risco , Calciofilaxia/diagnóstico , Diálise/efeitos adversos
12.
Nefrologia ; 38(6): 579-586, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30415999

RESUMO

Calciphylaxis, also known as calcific uraemic arteriolopathy, is a rare syndrome that typically causes skin necrosis and usually affects dialysis patients. Its pathogenesis is multifactorial and is the consequence of many factors causing ectopic calcifications in patients with chronic kidney disease, such as calcium-phosphate metabolism disorders, hyper- or hypo-parathyroidism, diabetes, obesity, systemic inflammation and the use of vitamin K antagonists, among others. From a clinical point of view, calciphylaxis may progress from painful purpura to extensive areas of skin necrosis that can potentially lead to superinfection and the death of the patient due to sepsis. Treatment is primarily based on managing the wounds, eliminating all the possible precipitating factors of ectopic calcification and administering agents which are capable of inhibiting the process of calcification.


Assuntos
Calciofilaxia/etiologia , Insuficiência Renal Crônica/complicações , Calciofilaxia/diagnóstico , Calciofilaxia/terapia , Humanos , Diálise Renal , Insuficiência Renal Crônica/terapia , Fatores de Risco
13.
J Wound Ostomy Continence Nurs ; 45(6): 536-539, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30395130

RESUMO

BACKGROUND: Calciphylaxis, also called calcific uremic arteriolopathy, is a highly morbid syndrome characterized by calcium deposition and occlusion of small arterial vessels of the dermis and subdermal adipose tissue, leading to necrosis and gangrene. Penile involvement is rare and its management presents considerable challenges. CASE: We review the case of a 47-year-old man with end-stage renal disease managed with hemodialysis, diabetes mellitus, and urinary incontinence who presented with a painful necrotic lesion on his glans penis, and the second and third toes of his right foot. Following diagnosis of calciphylaxis of the toes and penis, he was conservatively managed with topical wound care, sodium thiosulfate adjustment of hemodialysis, and phosphate binder medications. Over the course of 2 months, his wound worsened in the setting of continued urinary incontinence, and before planned diversion with a suprapubic catheter, he progressed to gangrene and sepsis. After a goals-of-care discussion with the patient and family, he elected to forego debridement and was discharged on home-based palliative care. CONCLUSIONS: Penile calciphylaxis is a rare, life-threatening disease that portends a poor prognosis. Conservative principles for management include normalization of calcium phosphate levels and local wound care. Penectomy may not impact survival. Ultimately, each case is individualized, and we encourage establishing goals of care in collaborative discussion with an interdisciplinary care team, patient, and family.


Assuntos
Calciofilaxia/complicações , Falência Renal Crônica/complicações , Pênis/lesões , Calciofilaxia/diagnóstico por imagem , Calciofilaxia/etiologia , Desbridamento/métodos , Gerenciamento Clínico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/diagnóstico por imagem , Diálise Renal/métodos , Tomografia Computadorizada por Raios X/métodos
14.
Nephrol Ther ; 14(7): 548-553, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-30385137

RESUMO

BACKGROUND: Calciphylaxis or calcific uremic arteriolopathy (CUA) is a cutaneous disease with ulcerations secondary to calcification of cutaneous and subcutaneous small arteries and arterioles. It is a rare but severe disease with significant morbidity and mortality affecting 1 to 4% of dialysis patients. The circumstances of occurrence are multiple. CASE: We report the case of a severe bilateral lower limb calciphylaxis in a 69-year-old, obese, hemodialysis patient with a recent diagnosis of Graves' disease complicated with hypercalcemia and cardiac arrhythmia requiring the use of vitamin K antagonist. Complex and multidisciplinary therapeutic management (daily hemodialysis, sodium thiosulfate therapy, treatment of hypercalcemia by denosumab, hyperbaric oxygen therapy, meshed skin autograft) allowed complete healing of the lesions. CONCLUSION: This is the first description of AUC secondary to hyperthyroidism in a dialysis patient. Multidisciplinary care is essential to achieve clinical improvement in those critical situations.


Assuntos
Calciofilaxia/etiologia , Hipercalcemia/etiologia , Hipertireoidismo/complicações , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Calciofilaxia/terapia , Denosumab/uso terapêutico , Feminino , Humanos , Oxigenação Hiperbárica/métodos , Hipercalcemia/complicações , Hipercalcemia/terapia , Diálise Renal/métodos , Pele/patologia , Transplante de Pele/métodos , Tiossulfatos/uso terapêutico
15.
BMJ Case Rep ; 20182018 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-30361453

RESUMO

Calciphylaxis is a rare and life-threatening disease characterized by cutaneous arteriolar stenosis and vascular thrombosis leading to skin ischaemia and necrosis. While calciphylaxis occurs mostly in patients with end-stage renal disease, the disorder has been described in patients with normal renal function, namely non-uraemic calciphylaxis (NUC). A 41-year-old African-American woman presented with a painful ulcerative rash on her thighs and right buttock 2 months after undergoing an orthotopic liver transplantation. She underwent debridement of the lesions and an excisional biopsy of one of the lesions, which revealed calciphylaxis. She was treated with sodium thiosulfate, cinacalcet and hyperbaric oxygen with complete resolution of the lesions 4-5 months after presentation. While she was treated with a course of high-dose glucocorticoids after the transplant, she did not have other risk factors for calciphylaxis. NUC should be considered in the differential diagnosis of necrotic skin lesions in postliver transplant patients.


Assuntos
Calciofilaxia/etiologia , Transplante de Fígado/efeitos adversos , Adulto , Nádegas , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Transplantados , Transplante Homólogo
16.
Skinmed ; 16(4): 235-237, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30207525

RESUMO

Calciphylaxis is a rare and severe syndrome of vascular calcification with unclear pathogenesis. This disease mainly affects patients with end-stage renal disease; however, it also has been described in nonuremic patients. We report four cases of nonuremic calciphylaxis (NUC) with ulcerated lesions associated with autoimmune disease. These cases support the literature suggesting that bisphosphonates and sodium thiosulfate are effective drugs in the treatment of calciphylaxis regardless of renal function.


Assuntos
Doenças Autoimunes/complicações , Calciofilaxia/etiologia , Calciofilaxia/patologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
J Wound Ostomy Continence Nurs ; 45(6): 532-535, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30216332

RESUMO

BACKGROUND: Calciphylaxis is a potentially life-threatening condition involving painful necrotic skin ulcerations, especially of the lower extremities. It is generally associated with chronic kidney failure but may be seen in nonuremic cases. CASE REPORT: We report a case of calciphylaxis in a 60-year-old man with diabetes on dialysis for end-stage renal disease and known to have other typical combination of risk factors associated with calciphylaxis syndrome. On examination, he presented with multiple intensely painful calciphylaxis wounds on his legs and ankles. Despite regular wound management of his condition in our ambulatory care setting, his ulcers deteriorated. The patient's pain also increased and he was referred for hospital admission. CONCLUSION: This case presentation emphasizes the importance of an interdisciplinary team in the treatment of the complex, life-threatening cutaneous manifestations of calciphylaxis. When indicated, prompt referral to a hospital setting is necessary for appropriate care.


Assuntos
Calciofilaxia/diagnóstico , Falência Renal Crônica/complicações , Calciofilaxia/diagnóstico por imagem , Calciofilaxia/etiologia , Complicações do Diabetes , Diálise/métodos , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
19.
Am J Nephrol ; 48(3): 168-171, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30176675

RESUMO

Calciphylaxis is a disease of dermal arteriolar calcification that results in necrosis. It commonly occurs in individuals with end-stage renal disease (ESRD) on hemodialysis and is associated with a high morbidity and mortality. Warfarin use is an identified risk factor. Twenty patients with ESRD on dialysis with calciphylaxis who were treated with apixaban for indications of deep vein thrombosis or atrial fibrillation were identified. There were no reports of thrombosis. Three individuals experienced bleeding requiring a transfusion, and anticoagulation was resumed without further event. Findings suggest that apixaban may be a safe and effective alternative to warfarin in patients with ESRD on dialysis with calciphylaxis.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Calciofilaxia/etiologia , Inibidores do Fator Xa/administração & dosagem , Falência Renal Crônica/complicações , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Trombose Venosa/tratamento farmacológico , Idoso , Fibrilação Atrial/etiologia , Calciofilaxia/sangue , Inibidores do Fator Xa/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/etiologia
20.
Mayo Clin Proc ; 93(9): 1202-1212, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30060958

RESUMO

OBJECTIVE: To define concomitant risk factors, treatment, and outcomes for patients with nonnephrogenic calciphylaxis (NNC). PATIENTS AND METHODS: A retrospective review of Massachusetts General Hospital (MGH) medical records (January 1, 2014, through February 29, 2016) and a systematic literature review of PubMed, Google Scholar, EMBASE, MEDLINE, and CENTRAL (August 1, 1970, through July 31, 2016) were performed. Demographic characteristics and concomitant features were summarized and compared between patients with different lesion characteristics. Outcomes (lesion improvement and mortality) and their predictors were analyzed. RESULTS: Nine patients (median age, 72 years [interquartile range (IQR), 44-82 years]; 78% women; 89% white race) were identified through MGH records. The literature review identified 107 patients (median age, 60 years [IQR, 49-72 years]; 77% women; 86% white race). Vitamin K antagonism and obesity were the most common concomitant factors. In the literature review, lower age (P<.001) and higher body mass index (P=.03) were associated with the central location of lesions, whereas vitamin K antagonism was associated with the peripheral location (P=.009). In the MGH series, median survival was 24.0 months (95% CI, 7.8-36.0 months), and 33% (95% CI, 14%-60%) had lesion improvement by 6 months. In the literature review, median survival was 4.2 months (95% CI, 1.9-5.9 months), median time to lesion improvement was 5.9 months (95% CI, 3.9-8.9 months), and none of the treatments were associated with lesion improvement or survival. CONCLUSION: This description of concomitant traits may augment an earlier recognition of NNC. Future research is needed to investigate NNC pathogenesis and treatments.


Assuntos
Calciofilaxia , Adulto , Idoso , Idoso de 80 Anos ou mais , Calciofilaxia/etiologia , Calciofilaxia/mortalidade , Calciofilaxia/terapia , Feminino , Humanos , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
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