Liječnički vjesnik, Vol. 137 No. 3-4, 2015.
Stručni rad
CALCIFIC UREMIC ARTERIOLOPATHY: CLINICAL FEATURES AND TREATMEN
Boris Kudumija
Mladen Knotek
Draško Pavlović
Sonja Dits
Sažetak
Calcific uremic arteriolopathy or calciphylaxis is a malignant form of calcification of small arteries and arterioles, usually present in patients with chronic kidney disease and dialysis therapy. It causes high mortality. Histological distinctive feature are calcium deposits lining vascular intima. Calcification of medial muscle layer, inflammation and necrosis of subcutaneous adipose tissue are frequent. The disease begins with painful violaceous mottling, resembling livedo reticularis. The skin lesion progresses to ulcers and eschars, sometimes it becomes very vulnerable to secondary infection which can often develop into fatal sepsis. Our first patient with the proximal form of calciphylaxis died in repeated sepsis. The second patient with the distal form of calciphylaxis was treated successfully. The decisive moment was the use of calcimimetic. A multiinterventional strategy is likely to be more effective than any single therapy. It is necessary to regulate metabolism of calcium phosphate and secondary hyperparathyroidism. Effectiveness has been demonstrated using calcimimetics, sodium thiosulfate, oxygen therapy, careful application of biphosphonates and surgical procedures. Warfarin withdrawal is urgently recommended and subsequent vitamin K supplementation is appropriate. The control of infection is critically important and the use of carbonylated hemoglobin in the stage without infection could accelerate the wound healing.
Ključne riječi
Calciphylaxis – etiology, diagnosis, therapy; Kidney failure, chronic – complications; Arterioles – pathology; Skin ulcer – etiology
Hrčak ID:
172689
URI
Datum izdavanja:
5.5.2015.
Posjeta: 1.608 *