(uremic calcifying arteriolopathy)

Vascular calcifications (hydroxyapatite) in the dermis and subcutaneous adipose tissue leading to skin necrosis. It occurs in 1 to 4 % of adults with terminal kidney failure, but may be present (more rarely) in the absence of renal failure (so-called non uremic forms). Significant mortality due to sepsis or gangrene. Associated with hyperparathyroidism and high phospho-calcic product.

Central forms involve abdominal wall and the proximal part of the limbs while distal ones involve the extremities.

Purplish and painful skin plates and/or subcutaneous nodules get ulcerated and finally necrotic. XRays: calcifications of the small arteries of the dermis.

Other precipitating factors, in addition to renal failure: treatment by AVK or deficiency in vitamin K, primary or secondary hyperparathyroidism, diabetes mellitus, obesity, POEMS syndrome (see this term)

Treatment: in addition to local treatment, intensification of dialysis, vitamin K supplements, sodium thiosulfate injections.

Anesthetic implications:

renal failure, check the phosphocalcic status and INR (vitamin K)

References :

-        Feng J, Gohara M, Lazova R, Antaya RJ.
Fatal childhood calciphylaxis in a 10-year-old and literature review.
Pediatr Dermatol 2006; 23: 266-72.

-        Nigwekar SU, Thadhani R, Brandenburg VM.
Calciphylaxis.
NEJM 2018; 378: 1704-14.

Updated: May 2018