1999 Resident Poster Competition
Yugandhar Chimata M.D.
St. Luke's Medical Center
Calcific Uremic Arteriolopathy (CUA): A Report of Six Cases
Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a life threatening condition reported in chronic renal failure (CRF) patients. It is pathologically characterized by medial calcification and intimal hyperplasia of cutaneous and subcutaneous microvasculature, resulting in progressive necrosis of subcutaneous tissue and fat. Clinically it manifests as livedo reticularis and painful plaque-like subcutaneous nodules which invariably ulcerate and become infected, leading to sepsis and death. To date, about 200 cases of CUA have been reported in the literature. Here we report 6 cases diagnosed in our hospital over a two year period. They were all CRF patients on hemodialysis or peritoneal dialysis. Subcutaneous lesions were initially found on the lower extremities in all 6 patients and subsequently ulcerated in 5 patients. Transcutaneous oxymetry, done in 3 cases, over the nodules revealed moderate to severe hypoxia with no improvement even after 100% 02. Calcium x Phosphorus product and PTH were high in 3 patients and within normal range in the other 3 patients. The diagnosis was confirmed in 5 patients by biopsy. One patient underwent repeated debridement, skin grafts, and hyperbaric 02 therapy without success. She developed sepsis and multi-organ failure. Realizing the poor prognosis, she decided to enter the hospice program and died a few days later. Two patients died of comorbid conditions.
In conclusion, CUA heralds a poor prognosis and is underdiagnosed. For the first time, We have used oxymetry studies of the skin as an adjunct tool in the diagnosis of CUA. Role of tissue oxymetry as an adjunct in or as an alternative to biopsy in the diagnosis of CUA needs to be investigated further. Currently there is no definitive and effective treatment for this condition.
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Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
