Calciphylaxis in man. A syndrome of tissue necrosis and vascular calcification in 11 patients with chronic renal failure

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Abstract
Patients (11) with chronic renal failure and presumed secondary hyperparathyroidism developed a syndrome of medial calcinosis of the arteries and painful ischemic ulcers of the fingers, legs, or thighs or any combination of the 3. Five patients required maintenance hemodialysis; 6 had functioning renal homografts. Severe hyperphosphatemia had existed in each; 7 showed roentgenographic evidence of subperiosteal resorption. Similarities were evident between the lesions and experimentally produced calciphylaxis. The lesions demonstrated a relentless, progressive course, with serious morbidity and mortality. Hyperplastic or adenomatous parathyroid tissue was removed from 10 of 11 patients undergoing surgical procedures; healing followed in 7 patients. Treatment with phosphate-binding antacids to lower serum phosphorus levels may prevent this syndrome. Total or subtotal parathyroidectomy should be considered when ischemic skin lesions appear in uremic patients or in renal transplant recipients.

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