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Calcific Uremic Arteriopathy
IMAGES
IN THE
MEDICAL SCIENCES
Calcific Uremic Arteriopathy Mei-Han Wu, MD, Shang-Feng Yang, MD and Yao-Ping Lin, MD, PhD* *Division of Nephrology, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
FIGURE 2
CASE PRESENTATION
47-year-old woman with diabetes mellitus and end-stage renal disease experienced frequent chest tightness and abdominal pain during hemodialysis and excruciating pain in the lower limbs. Noncontrast computed tomography revealed diffuse coronary artery calcification (Figure 1). There was also extensive atherosclerotic change, irregular calcifications and luminal narrowing over the aorta and arterial trees and evidence of previous right lower limb amputation (Figure 2). Uremic patients suffer from premature vascular aging with evidence of accelerated atherosclerosis and vascular calcifications. The risk factors include older age, hypertension, dyslipidemia and deranged calcium-phosphate homeostasis. The vascular calcifications could cause arterial stiffening and compromise tissue perfusion.1 Our patient had the precipitating
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factors of increased calcium-phosphorus product (75 mg2/dL2) and secondary hyperparathyroidism (intact parathyroid hormone 5 1400 pg/mL) that lead to calciphylaxis, a syndrome of arterial calcification and tissue necrosis with very high mortality due to infection.2 The patient eventually died of cardiovascular disease due to diffuse vasculopathy during this hospitalization. REFERENCES 1. London GM, Marchais SJ, Guérin AP, et al. Arteriosclerosis, vascular calcifications and cardiovascular disease in uremia. Curr Opin Nephrol Hypertens 2005;14:525–31. 2. Ross EA. Evolution of treatment strategies for calciphylaxis. Am J Nephrol 2011;34:460–7.
The American Journal of the Medical Sciences
Volume 347, Number 2, February 2014
IN THE
MEDICAL SCIENCES
Calcific Uremic Arteriopathy Mei-Han Wu, MD, Shang-Feng Yang, MD and Yao-Ping Lin, MD, PhD* *Division of Nephrology, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
FIGURE 2
CASE PRESENTATION
47-year-old woman with diabetes mellitus and end-stage renal disease experienced frequent chest tightness and abdominal pain during hemodialysis and excruciating pain in the lower limbs. Noncontrast computed tomography revealed diffuse coronary artery calcification (Figure 1). There was also extensive atherosclerotic change, irregular calcifications and luminal narrowing over the aorta and arterial trees and evidence of previous right lower limb amputation (Figure 2). Uremic patients suffer from premature vascular aging with evidence of accelerated atherosclerosis and vascular calcifications. The risk factors include older age, hypertension, dyslipidemia and deranged calcium-phosphate homeostasis. The vascular calcifications could cause arterial stiffening and compromise tissue perfusion.1 Our patient had the precipitating
146
factors of increased calcium-phosphorus product (75 mg2/dL2) and secondary hyperparathyroidism (intact parathyroid hormone 5 1400 pg/mL) that lead to calciphylaxis, a syndrome of arterial calcification and tissue necrosis with very high mortality due to infection.2 The patient eventually died of cardiovascular disease due to diffuse vasculopathy during this hospitalization. REFERENCES 1. London GM, Marchais SJ, Guérin AP, et al. Arteriosclerosis, vascular calcifications and cardiovascular disease in uremia. Curr Opin Nephrol Hypertens 2005;14:525–31. 2. Ross EA. Evolution of treatment strategies for calciphylaxis. Am J Nephrol 2011;34:460–7.
The American Journal of the Medical Sciences
Volume 347, Number 2, February 2014