Skip to main content

Advertisement

SpringerLink
Log in

Penile calciphylaxis in a patient on combined peritoneal dialysis and hemodialysis

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Calciphylaxis presents with painful purpura and intractable skin ulcers on the trunk and particularly the distal extremities, and it mainly occurs in patients on chronic dialysis. A 66-year-old man with renal failure due to diabetic nephropathy was on peritoneal dialysis alone for 1 year, followed by peritoneal dialysis combined with hemodialysis for 3 years. He developed calciphylaxis of the penis, which was diagnosed from the skin biopsy findings and clinical observation. To treat this condition, PD was stopped and HD was performed three times a week. In addition, warfarin therapy was discontinued and infusion of sodium thiosulfate was performed. The penile ulcers decreased in size and pain was markedly improved, so the patient was discharged from hospital. Following discharge, PD was resumed after changing the peritoneal dialysis fluid to bicarbonate-buffered dialysate. The penile ulcers eventually resolved completely. There have been very few reports about calciphylaxis in patients on combined dialysis modalities. In our patient, penile calciphylaxis progressed when lactate-buffered peritoneal dialysis fluid was used and resolved after switching to bicarbonate-buffered fluid together with cessation of warfarin therapy and infusion of sodium thiosulfate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rogers NM, Coates PT. Calcific uraemic arteriolopathy: an update. Curr Opin Nephrol Hypertens. 2008;17(6):629–34.

    Article  Google Scholar 

  2. Weenig RH. Pathogenesis of calciphylaxis: Hans Selye to nuclear factor k-B. J Am Acad Dermatol. 2008;58(3):458–71.

    Article  Google Scholar 

  3. Daudén E, Oñate MJ. Calciphylaxis. Dermatol Clin. 2008;26(4):557–68.

    Article  Google Scholar 

  4. Ng AT, Peng DH. Calciphylaxis. Dermatol Ther. 2011;24(2):256–62.

    Article  Google Scholar 

  5. New N, Mohandas J, John GT, et al. Calcific uremic arteriolopathy in peritoneal dialysis populations. Int J Nephrol. 2011;2011:982854.

    Article  Google Scholar 

  6. Ramani R, Ramachandran A, Ravindran S, Kurian GA. Erythrocyte membrane bound atpase and antioxidant enzyme changes associated with vascular calcification is reduced by sodium thiosulfate. Indian J Clin Biochem. 2017;32(4):487–92.

    Article  CAS  Google Scholar 

  7. Bleyer AJ, Choi M, Igwemezie B, de la Torre E, White WL. A case–control study of proximal calciphylaxis. Am J Kidney Dis. 1998;32(3):376–83.

    Article  CAS  Google Scholar 

  8. Mazhar AR, Johnson RJ, Gillen D, Stivelman JC, Ryan MJ, Davis CL, Stehman-Breen CO. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney Int. 2001;60(1):324–32.

    Article  CAS  Google Scholar 

  9. Fine A, Zacharias J. Calciphylaxis is usually nonulcerating: risk factors, outcome and therapy. Kidney Int. 2002;61(6):2210–7.

    Article  Google Scholar 

  10. Weenig RH, Sewell LD, Davis MD, McCarthy JT, Pittelkow MR. Calciphylaxis: natural history, risk factor analysis, and outcome. J Am Acad Dermatol. 2007;56(4):569–79.

    Article  Google Scholar 

  11. Ando R. Skin complications associated with dialysis 3. Calciphylaxis. Jpn J Clin Dial 2009;25(7):126–34 (in Japanese).

    Google Scholar 

  12. Paul S, Carlos AR, Vedak P, et al. The role of bone scintigraphy in the diagnosis of calciphylaxis. JAMA Dermatol. 2017;153(1):101–3.

    Article  Google Scholar 

  13. Pliquentt RU, Schwock J, Padchke R, Achenbach H. Calciphylaxis in chronic, non-dialysis-dependent renal disease. BMC Nephrol. 2003;4:8.

    Article  Google Scholar 

  14. Zhang Y, Corapi KM, Luongo M, Nigwekar SU. Calciphylaxis in peritoneal dialysis patients: a single cohort study. Int J Nephrol Renovasc Dis. 2016;9:235–41.

    Article  CAS  Google Scholar 

  15. Angelis M, Wong LL, Myers SA, Wong LM. Calciphylaxis in patients on hemodialysis: a prevalence study. Surgery. 1997;122(6):1083–9.

    Article  CAS  Google Scholar 

  16. Dosanjh A, Kebebew E. Calciphylaxis. Rare but Fatal. Curr Surg. 2005;62(5):455–8.

    Article  Google Scholar 

  17. Chen W, Abramowitz MK. Treatment of metabolic acidosis in patients with CKD. Am J Kidney Dis. 2014;63(2):311–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Takahiro Kasai, Naoki Washida, Hirokazu Muraoka, Kentarou Fujii, Kiyotaka Uchiyama, Keisuke Shinozuka, Kohkichi Morimoto, Hirobumi Tokuyama, Shu Wakino & Hiroshi Itoh

  2. Department of Nephrology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan

    Naoki Washida

Authors
  1. Takahiro Kasai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Washida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirokazu Muraoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kentarou Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kiyotaka Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keisuke Shinozuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kohkichi Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirobumi Tokuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shu Wakino
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroshi Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naoki Washida.

Ethics declarations

Conflict of interest

The authors have no financial conflicts of interest to declare.

Human rights

All procedures performed in studies involving this participant was in accordance with the ethical standards of the institutional and national research committee at which the studies were conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient included in this study.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kasai, T., Washida, N., Muraoka, H. et al. Penile calciphylaxis in a patient on combined peritoneal dialysis and hemodialysis. CEN Case Rep 7, 204–207 (2018). https://doi.org/10.1007/s13730-018-0327-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-018-0327-0

Keywords

Search

Navigation