Calciphylaxis in kidney graft recipient with type 1 diabetes: A case report

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Calcifylaxis — calcifying uremic arteriolopathy — is a rare disease that occurs in patients with chronic kidney disease and is characterized by progressive calcification of small-caliber skin vessels and thrombosis of small (arterioles), accompanied by necrosis of the skin, subcutaneous tissue and soft tissues with severe pain syndrome. The article describes a patient with a long-term, severe course of diabetes mellitus, the development of diabetic nephropathy with an outcome in terminal renal failure, which required renal replacement therapy with peritoneal dialysis and kidney transplantation. In the posttransplantation period, the patient registered the occurrence of calcifylaxis, which is a rare complication.

The lack of treatment protocols for calcifylaxis in patients with chronic kidney disease requires further research. It is important to constantly monitor patients with risk factors for the development of this serious disease and timely treatment, which will improve their condition and slow down the progression of the process.

Full Text

Restricted Access

About the authors

Valentina V. Polykova

North-Western State Medical University named after I.I. Mechnikov

Email: valentina.polyakova@szgmu.ru
ORCID iD: 0000-0001-9148-4546

md, cand. sci. (med.), assistant professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Irina Yu. Matezius

North-Western State Medical University named after I.I. Mechnikov

Email: imatezius@yandex.ru
ORCID iD: 0000-0002-8694-9756

md, cand. sci. (med.), assistant professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Elizaveta V. Fomina

North-Western State Medical University named after I.I. Mechnikov

Email: 4891190@mail.ru
ORCID iD: 0009-0002-4905-1573
Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Zakhar V. Lopatin

North-Western State Medical University named after I.I. Mechnikov

Email: zakhar.lopatin@szgmu.ru
ORCID iD: 0000-0001-7283-9911

md, cand. sci. (med.), assistant professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Elena V. Semenova

North-Western State Medical University named after I.I. Mechnikov

Email: elenalokb@yandex.ru
ORCID iD: 0000-0003-2955-9097

md, cand. sci. (med.), assistant professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Irina V. Ulyankina

Academician I.P. Pavlov First St. Petersburg State Medical Universitya; Saint Petersburg Scientific Research Institute of Emergency Medicine named after. I.I. Dzhanelidze

Author for correspondence.
Email: spb.yl@mail.ru
ORCID iD: 0000-0001-9207-520X

md, cand. sci. (med.)

Russian Federation, Saint-Petersburg

References

  1. Podestà MA, Ciceri P, Galassi A, Cozzolino M. Calciphylaxis after kidney transplantation: a rare but life-threatening disorder. Clin Kidney J. 2022;15(4):611–614. doi: 10.1093/ckj/sfab247
  2. Abbas H, Alotaibi M, Lebron R. A case report: Calciphylaxis presenting as digital ischemia in patient with end stage kidney disease on peritoneal dialysis. Open J Nephrol. 2019;9:49–53. doi: 10.4236/ojneph.2019.92006
  3. Nigwekar SU, Zhao S, Wenger J, et al. A nationally representative study of calcific uremic arteriolopathy risk factors. J Am Soc Nephrol. 2016;27(11):3421–3429. doi: 10.1681/ASN.2015091065
  4. Baby D, Upadhyay M, Joseph MD, et al. Calciphylaxis and its diagnosis. J Family Med Prim Care. 2019;8(9):2763–2767. doi: 10.4103/jfmpc.jfmpc_588_19
  5. Ryan MP, Ross LS. Calciphylaxis after kidney transplant. Cureus. 2019;11(5):e4695. doi: 10.7759/cureus.4695
  6. Gabel CK, Nguyen ED, Chakrala T, et al. Assessment of outcomes of calciphylaxis. J Am Acad Dermatol. 2021;85(4):1057–1064. doi: 10.1016/j.jaad.2020.10.067
  7. Shuman H, Obri MS, Artz C, et al. Nonuremic calciphylaxis precipitated by COVID-19 infection. Cureus. 2022;14(3):e22796. doi: 10.7759/cureus.22796
  8. Nigwekar SU, Kroshinsky D, Nazarian RM, et al. Calciphylaxis: risk factors, diagnosis, and treatmen. Am J Kidney Dis. 2015;66(1):133–146. doi: 10.1053/j.ajkd.2015.01.034
  9. Guillén E, Torregrosa JV, Garcia-Herrera A, et al. Development of calciphylaxis in kidney transplant recipients with a functioning graft. Clin Kidney J. 2021;15(4):663–671. doi: 10.1093/ckj/sfab205
  10. Nefrologiya. Klinicheskie rekomendatsii. Ed. by E.M. Shilov, A.V. Smirnov, N.L. Kozlovskaya. Moscow; 2019. P. 736–740 p. (In Russ.)
  11. Brandenburg V, Adragao T, van Dam B, et al. Blueprint for a European calciphylaxis registry initiative: the European Calciphylaxis Network (EuCalNet). Clin Kidney J. 2015;8:567–571. doi: 10.1093/ndt/gfv438
  12. Nigwekar SU, Zhao S, Wenger J, et al. A nationally representative study of calcific uremic arteriolopathy risk factors. J Am Soc Nephrol. 2016;27:3421–3429. doi: 10.1681/ASN.2015091065
  13. Brandenburg VM, Kramann R, Rothe H, et al. Calcific uraemic arteriolopathy (calciphylaxis): data from a large nationwide registry. Nephrol Dial Transplant. 2017;32(1):126–132. doi: 10.1093/ndt/gfv438
  14. Udomkarnjananun S, Kongnatthasate K, Praditpornsilpa K, et al. Treatment of calciphylaxis in CKD: a systematic review and meta-analysis. Kidney Int Rep. 2018;4(2):231–244. doi: 10.1016/j.ekir.2018.10.002
  15. Kodumudi V, Jeha GM, Mydlo N, Kaye AD. Management of cutaneous calciphylaxis. Adv Ther. 2020;37(12):4797–4807. doi: 10.1007/s12325-020-01504-w
  16. Gaisne R, Péré M, Menoyo V, et al. Calciphylaxis epidemiology, risk factors, treatment and survival among French chronic kidney disease patients: a case-control study. BMC Nephrol. 2020;21(1):63. doi: 10.1186/s12882-020-01722-y
  17. Jeong HS, Dominguez AR. Calciphylaxis: controversies in pathogenesis, diagnosis and treatment. Am J Med Sci. 2016;351(2):217–227. doi: 10.1016/j.amjms.2015.11.015
  18. Sinha S, Gould LJ, Nigwekar SU, et al. The CALCIPHYX study: a randomized, double-blind, placebo-controlled, phase 3 clinical trial of SNF472 for the treatment of calciphylaxis. Clin Kidney J. 2022;15:136–144. doi: 10.1093/ckj/sfab117
  19. Ricardo VB, Egido J. Phosphate, pyrophosphate, and vascular calcification: a question of balance. Eur Heart J. 2017;38(23):1801–1804. doi: 10.1093/eurheartj/ehv605
  20. Egshatyan LV, Mokrysheva NG. Ectopic calcification in chronic kidney disease. Part 1. Classification and pathogenesis. Nephrology (Saint-Petersburg). 2017;21(4):30–39. (In Russ.) doi: 10.24884/1561-6274-2017-21-4-30-39
  21. Ruderman I, Toussaint ND, Hawley CM, et al. The Australian calciphylaxis registry: reporting clinical features and outcomes of patients with calciphylaxis. Nephrol Dial Transplant. 2021;36:649–656. doi: 10.1093/ndt/gfz256
  22. Musso CG, Enz PA, Kowalczuk A, et al. Differential diagnosis of calciphylaxis in chronic dialysis patients. Int Urol Nephrol. 2020;52(3):595–597. doi: 10.1007/s11255-020-02388-z
  23. Westphal SG, Plumb T. Calciphylaxis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  24. Yu WY, Bhutani T, Kornik R, et al. Warfarin-associated nonuremic calciphylaxis. JAMA Dermatol. 2017;153(3):309–314. doi: 10.1001/jamadermatol.2016.4821
  25. Cianciolo G, Capelli I, Angelini ML, et al. Importance of vascular calcification in kidney transplant recipients. Am J Nephrol. 2014;39:418–426. doi: 10.1159/000362492
  26. Ponticelli C, Glassock RJ. Prevention of complications from use of conventional immunosuppressants: a critical review. J Nephrol. 2019;32(6):851–870. doi: 10.1007/s40620-019-00602-5
  27. Guillén E, Torregrosa JV, Garcia-Herrera A, et al. Development of calciphylaxis in kidney transplant recipients with a functioning graft. Clin Kidney J. 2022;15(4):663–671. doi: 10.1093/ckj/sfab205

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Patient E. Necrosis in the area of the terminal phalanx of the IV finger of the right hand

Download (70KB)
Indexing metadata
3. Fig. 2. Patient E. X-ray of the hands (vascular calcification)

Download (66KB)
Indexing metadata

Copyright (c) 2023 Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 70763 от 21.08.2017 г.