Calcific uraemic arteriolopathy (CUA) is a rare syndrome characterized by painful skin lesions with a mortality with chronic renal disease is reported to be 60–80%
- Rare phenomenon characterized by diffuse calcium deposits
- Calcium deposition in small blood vessels causes painful necrosis
- Usually seen in end stage renal failure
- Warfarin (better prognosis)
- Calcium-based phosphate binders (Calcitriol etc.)
- End stage renal failure
- There is necrosis (cellular death) of the skin and fatty tissue
- Uncontrolled hyperparathyroidism may not be the man cause.
- Extensive tender necrotic ulcers
- Legs, abdomen and gluteal, genitals
- Eschar formation surrounded by violaceous plaques
- Skin involvement is most common
- Other organs can be involved
- U&E: end stage renal failure
- PTH: may be elevated
- Phosphate: high
- CRP: elevated
Death is less likely when warfarin is the cause of calciphylaxis, with 15 of 18 patients reported to have fully recovered.
- Mortality is high, up to a year survival post-diagnosis of Calciphylaxis. Pain control and wound care are key
- Consider using non-calcium PO4 binders (Sevelamer/cinacalcet) low lower PTH
- Treatments suggested include hyperbaric oxygen and sodium thiosulfate infusions.
- Early Palliation for pain management if prognosis is bad