scholarly journals Surgical Management of Calciphylaxis Associated with Primary Hyperparathyroidism: A Case Report and Review of the Literature

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Jennifer Bishop ◽  
Eric Brown ◽  
Augusto Podesta ◽  
Cathrine Troy ◽  
Xiang (Eric) Dong
Keyword(s):  
Primary Hyperparathyroidism ◽  
English Literature ◽  
High Rate ◽  
Medical Problems ◽  
Extensive Calcification ◽  
Calcific Uremic Arteriolopathy ◽  
Mediastinal Parathyroid Adenoma ◽  
Stage Renal Disease ◽  
End Stage ◽  
Mediastinal Parathyroid

Calciphylaxis, or calcific uremic arteriolopathy, commonly affects people with end-stage renal disease and carries with it a high rate of morbidity and mortality. Here, we present the unusual case of a 56-year-old woman, with extensive medical problems, who developed calciphylaxis in the presence of primary hyperparathyroidism. Our patient initially presented with bilateral, exquisitely tender thigh lesions. The diagnosis of calciphylaxis was rendered histologically by extensive calcification of the subcutaneous blood vessels. Subsequent parathyroidectomy identified the presence of a hyperactive mediastinal parathyroid adenoma, weighing 0.62 grams. Postoperatively, the patient had normalization of hypercalcemia and parathyroid hormone levels, with subsequent healing of her thigh wounds. Currently, there have been sixteen cases described in the English literature, with only nine being offered a potentially therapeutic parathyroidectomy. It is contingent upon the vigilant physician to diagnose and properly manage this difficult yet treatable condition.

scholarly journals Persistent Calciphylaxis and Secondary Hyperparathyroidism in End Stage Renal Disease Patient Due to Ectopic Mediastinal Parathyroid Adenoma- A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A211-A212
Author(s):  
Randa Abdelmasih ◽  
Ramy Abdelmaseih ◽  
Elio Paul Monsour ◽  
S Mustajab Hasan ◽  
Josef James Karl Vesely
Keyword(s):  
Secondary Hyperparathyroidism ◽  
End Stage Renal Disease ◽  
Parathyroid Tissue ◽  
Phosphorus Level ◽  
Ectopic Parathyroid ◽  
Mediastinal Parathyroid Adenoma ◽  
Stage Renal Disease ◽  
End Stage ◽  
Mediastinal Parathyroid ◽  
Pth Level

Abstract Intruducion: Secondary hyperparathyroidism (SHPT) is prevalent in patients with end-stage renal disease (ESRD) with reported prevalence of 90%. SHPT treatment is usually medical. Although 5% ends up with parathyroidectomy. Indications of parathyroidectomy in ESRD patients include persistent elevation of PTH more than 800, Calcyphylaxis, Osteitis Fibrosa Cystica, and persistent anemia. Among these patients who require surgery, 5–20% present with persistent or recurrent disease and require further re-exploration and excision of parathyroid tissue. We present a case of persistent Calciphylaxis and SHPT in ESRD patient despite Parathyroidectomy which prompted diagnosing an ectopic mediastinal parathyroid adenoma. Case Presentation: 49 year-old male with ESRD for 15 years complicated with SHPT, presented due to worsening Caciphylaxis of bilateral lower extremities despite Cinacalcet, IV sodium thiosulfate, and Phosphate binder. Serum Calcium level was 9.0 mg/dl with corrected levels of 10.2 mg/dl, Phosphorus level of 9.3 with Intact PTH level 1,369 pg/ml. Ultrasound of parathyroid glands was normal. Due to failure of medical treatment, He underwent Total parathyridectomy and left arm parathyroid autograft. Intraoperative PTH level went down to 300 (less than 50%). Calciphylaxis never improved. 5 months later, Parathyroid hormone was elevated 1338 pg/ml, Calcium level 6.9 mg/dl and Phosphorus level 10.0 mg/dl. 99mTc-sestamibi parathyroid scan didn’t show any activity in thyroid gland area and no increased uptake at the autograft area. Although it showed a small focus of persistent activity in substernal area suggestive of ectopic parathyroid tissue. Patient was referred for removal of ectopic adenoma. Discussion: Persistent SHPT is identified as the persistence or recurrence of symptoms, lab abnormalities and radiologic findings within 6 months after parathyroidectomy. Pathophysiology of recurrence is not well studied but one theory suggests that in SHPT, altered Calcium-phosphate hemostasis leads to hyperplasia of parathyroid tissue including ectopic and supernumerary tissue. This aforementioned altered hemostasis continues even after parathyroidectomy and cause hyperplasia and hyperfunction of the residual parathyroid tissue left accidentally by seeding within surgical site or implanted autograft or It can present with ectopic adenoma, even if they were undetected prior to or in the first intervention. Ectopic parathyroid tissue is an uncommon etiology of persistent or recurrent secondary hyperparathyroidism, it is reported in many cases where it was missed at initial workup. Prevalence reported up to 14% in patients with persistent SHPT. It is warranted further investigations to look for ectopic parathyroid tissue in patients with ESRD who present with recurrent or persistent secondary hyperparathyroidism after total parathyroidectomy with reimplantation.

scholarly journals Removing the problem: parathyroidectomy for calciphylaxis

2018 ◽  
Vol 11 (1) ◽  
pp. e226696 ◽  
Author(s):  
Mohamed Hassanein ◽  
Heather Laird-Fick ◽  
Richa Tikaria ◽  
Saleh Aldasouqi
Keyword(s):  
Treatment Options ◽  
Sodium Thiosulfate ◽  
Skin Lesions ◽  
Phosphate Binders ◽  
Treatment Resistant ◽  
Hungry Bone Syndrome ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hungry Bone

Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.

scholarly journals Prevalence of clinically validated primary causes of end-stage renal disease (ESRD) in a State Capital in Northeastern Brazil

2018 ◽  
Vol 40 (2) ◽  
pp. 130-135 ◽  
Author(s):  
Luana Rodrigues Sarmento ◽  
Paula Frassinetti Castelo Branco Camurça Fernandes ◽  
Marcelo Ximenes Pontes ◽  
Daniel Barros Santos Correia ◽  
Victhor Castelo Branco Chaves ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Primary Hypertension ◽  
High Rate ◽  
Northeastern Brazil ◽  
State Capital ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT Introduction: Knowledge of validated primary causes of end-stage renal disease (ESRD) is extremely relevant in the realm of public health. The literature lacks validated studies on the primary causes of ESRD. Objective: The aim of this study was to estimate the prevalence of the causes of ESRD in a State Capital in Northeastern Brazil. Methods: This cross-sectional study was based on the analysis of medical records of patients on hemodialysis at five specialized centers in Fortaleza, CE, Brazil. Deaths and patients referred to other centers outside Fortaleza were excluded from the study. The data of 830 patients were initially collected, but 818 remained enrolled after the exclusion criteria were applied, the equivalent to 48% of the patents on dialysis in the city. Results: 61.1% of the patients were males. Twenty-two percent of all enrolled individuals were aged 60-69 years. Patient mean age was 55.7 ± 16 years. The most common validated cause of ESRD was unknown (35.3%), followed by diabetes mellitus (26.4%), adult polycystic kidney disease (6.2%), graft failure (6.2%), obstructive uropathy (5.7%), and primary glomerulonephritis (5.3%). Before validation, primary hypertension was the most frequent cause of chronic kidney disease (22.9%), decreased to 3.8% after validation. Conclusion: The data contradicted national studies reporting primary hypertension as the main cause of chronic kidney disease (CKD). A high rate of unknown causes and categorization bias were observed mainly in relation to primary hypertension as a cause of CKD, which affects the overall prevalence of causes of ESRD in patients on dialysis.

Calcific Uremic Arteriolopathy

2013 ◽  
Vol 24 (3) ◽  
pp. 285-300
Author(s):  
Kimberly G. Anderson
Keyword(s):  
Early Recognition ◽  
Renal Dialysis ◽  
Optimal Level ◽  
Health Care Team ◽  
Team Approach ◽  
Clear Understanding ◽  
Treatment Plans ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage

Calcific uremic arteriolopathy is a little understood diagnosis of increasing prevalence seen predominantly in patients with chronic kidney disease, particularly those who are approaching end-stage renal disease, who are undergoing renal dialysis, and who have secondary hyperparathyroidism. Calcific uremic arteriolopathy affects women more frequently than men, at a ratio of 3:1, and the median age at diagnosis is 48 years. A clear understanding of the pathogenesis and definitive plans of care are lacking. Nurses should be familiar with the clinical picture of calcific uremic arteriolopathy. Early recognition is important to develop optimal treatment plans and to limit progression of this rare but often fatal disease. Nurses have a pivotal role in maintaining the patient’s comfort and dignity, while setting realistic goals of care. Calcific uremic arteriolopathy remains a rare and complex clinical condition that requires a multidisciplinary health care team approach to provide the optimal level of care. Nurses have an essential role in the care of patients with the diagnosis of calcific uremic arteriolopathy.

Extracutaneous Manifestations of Calciphylaxis: Ogilvie’s Syndrome With Perforation

2020 ◽  
Vol 86 (5) ◽  
pp. 546-548
Author(s):  
Thomas A. Mitchell ◽  
Zachary S. Hoffer ◽  
Leopoldo C. Cancio
Keyword(s):  
Surgical Intervention ◽  
Rare Entity ◽  
Colonic Ischemia ◽  
Ogilvie's Syndrome ◽  
Cutaneous Lesions ◽  
Total Abdominal Colectomy ◽  
Ogilvie’S Syndrome ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage

Calciphylaxis or calcific uremic arteriolopathy is a rare entity associated with the end-stage renal disease that presents with necrotic cutaneous lesions that may require surgical management. Extracutaneous manifestations of calciphylaxis including visceral ischemia have been reported; however, surgical intervention for colonic ischemia has only been reported twice. We report a 49-year-old male with calciphylaxis who subsequently developed Ogilvie’s syndrome complicated by perforation requiring total abdominal colectomy with end ileostomy. Surgeons treating this disease should have a heightened awareness of the extracutaneous sequelae of calciphylaxis.

scholarly journals Fracture Cascade in Patients with End-Stage Renal Disease: Complications and Outcome

2018 ◽  
Vol 1 (1-3) ◽  
pp. 55-61
Author(s):  
Tarek M. Samy ◽  
Tarek M. Khalil ◽  
Maged Abouelsoud ◽  
Amr Abdelrahman ◽  
Mohamed B. Elghonimy
Keyword(s):  
Femoral Neck ◽  
Renal Disease ◽  
Femoral Neck Fracture ◽  
End Stage Renal Disease ◽  
Subtrochanteric Fracture ◽  
High Rate ◽  
Entry Site ◽  
Neck Fracture ◽  
Stage Renal Disease ◽  
End Stage

We report a 68-year-old end-stage renal disease female patient on dialysis for 15 years. She sustained consecutive fractures starting with left-sided femoral neck fracture, followed 16 months later by a right-sided one. On her recovery from her right hip injury she sustained a stress type subtrochanteric fracture at the entry site of the fixation implants and an ipsilateral humeral shaft fracture. Cementless total hip replacement was done for the left femoral neck, and osteosynthesis was done for her undisplaced right femoral neck fracture. Revision fixation was done for her right subtrochanteric fracture with a long Gamma nail that was statically locked. The humeral fracture was fixed with an interlocking nail in a closed manner. This case highlights the fact that sequential hip fractures is an ominous event which is likely to be followed by a quick cascade of bone injuries with trivial trauma and a high rate of unexpected complications. Our treatment approach is explained here, stressing the unexpected complications and challenges met.

scholarly journals Calciphylaxis in a Patient on Home Hemodialysis

2020 ◽  
Vol 8 ◽  
pp. 232470962092271 ◽  
Author(s):  
Sreedhar Adapa ◽  
Srikanth Naramala ◽  
Vijay Gayam ◽  
Narayana Murty Koduri ◽  
Subba Rao Daggubati ◽  
...  
Keyword(s):  
Wound Care ◽  
Sodium Thiosulfate ◽  
Skin Lesions ◽  
Current Treatment ◽  
Home Hemodialysis ◽  
Calcium Phosphorus ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Subcutaneous Adipose

Calciphylaxis is a rare and severe complication characterized by calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue that leads to ischemia, necrosis, and painful skin lesions in patients with end-stage renal disease (ESRD). It is also known as calcific uremic arteriolopathy. Calciphylaxis occurs most commonly with the ESRD with skin ulceration as a predominant presenting feature. Calcium-phosphorus dysregulation in dialysis patients are traditionally considered as a risk factor for the development of calciphylaxis. The involvement of an integrated interdisciplinary and multifaceted approach is key to the success of the calciphylaxis treatment. We present a case of a 51-year-old female with ESRD on home hemodialysis who developed calciphylaxis, which was successfully managed with increasing dialysis prescription, diligent wound care, and sodium thiosulfate infusion. Management of calciphylaxis in a patient receiving home hemodialysis has never been reported as per the review of the literature. Calciphylaxis is a sporadic disease, frequently encountered in the patients undergoing hemodialysis and carries a very grave prognosis. Current treatment is rarely effective, so preventive strategies play an important role by modifying the risk factors that promote the development of calciphylaxis.

scholarly journals Excision of an Elusive Tiny Ectopic Parathyroid Adenoma

2017 ◽  
Vol 10 (3) ◽  
pp. 1105-1111
Author(s):  
Andre Navarro ◽  
Josanne Vassallo ◽  
Joseph Galea
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Gamma Probe ◽  
Surrounding Tissue ◽  
Uneventful Recovery ◽  
Ectopic Parathyroid Adenoma ◽  
Ectopic Parathyroid ◽  
Mediastinal Parathyroid Adenoma ◽  
Upper Mediastinum ◽  
Mediastinal Parathyroid

An elderly lady was diagnosed with primary hyperparathyroidism after being admitted to hospital with pyelonephritis and constipation. A sestamibi parathyroid scan demonstrated increased uptake in the upper mediastinum, suggesting an ectopic mediastinal parathyroid adenoma. The 4-mm adenoma was successfully removed through a mini-sternotomy incision using a gamma probe to identify the gland from the surrounding tissue. The patient made an uneventful recovery.

Rehabilitation in End-Stage Renal Disease

1975 ◽  
Vol 6 (2) ◽  
pp. 96-105
Author(s):  
Ebra George
Keyword(s):  
Renal Disease ◽  
Social Factors ◽  
End Stage Renal Disease ◽  
Artificial Kidney ◽  
Medical Problems ◽  
Stage Renal Disease ◽  
End Stage

The patient who is afflicted with end-stage renal disease presents a variety of considerations for those who participate in his rehabilitation. The artificial kidney, while necessary and successful, is at best a palliative solution to the medical problems only. There are numerous complications that may evolve from the utilization of the artificial kidney. It is not this paper's intention to elaborate on the medical aspects of the disease, but rather to elucidate the psycho-social factors inherent in the formulation 'and execution of a successful plan of total rehabilitation for the client presenting terminal uremia.

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