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.
- renal medicine
- endocrine system
- calcium and bone
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Contributors MH participated in the care of the patient, analysed and interpreted the patient data, performed the literature review and drafted the manuscript. HL-F, RT and SA participated in interpreting patient data, editing, reviewing and critically revising the manuscript. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Dr. Aldasouqi received speakership honoraria from Janssen and Alere for Invokana (a diabetes medication) and Afinion (a diabetes device product) respectively.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.