Calcific Uremic Arteriolopathy (Calciphylaxis)

  • Earl H. Rudolph
  • Edgar V. Lerma


Calcific uremic arteriolopathy (CUA), also referred to as calciphylaxis, is a poorly understood syndrome of vascular calcification and cutaneous necrosis first described in 1898 when its presence was associated with uremia. At present, it is believed to be caused by arteriolar calcification and cutaneous plaque formation which causes vascular stenosis which predisposes to thrombotic occlusion causing tissue ischemia and violaceous skin lesions that may progress to nonhealing ulceration and gangrene which may lead to amputation, sepsis, and death. Although there are many reports of calciphylaxis associated with nonuremic causes, the majority of cases occur in patients with end-stage renal disease on dialysis. It is likely that uremia creates a favorable milieu for extraskeletal deposition of hydroxyapatite in soft tissues including small vessels, predisposing to thrombus formation, and the development of calciphylaxis. In this chapter, the authors present a discussion of the basic and clinical aspects of the disease process as well as novel therapeutic options.


Calciphylaxis Calcific uremic arteriolopathy Hyperparathyroidism Cutaneous Calcinosis Hyperphosphatemia Parathyroidectomy Hydroxyapatite Intimal Osteoblast Osteoprotegerin Fetuin-A Bone morphogenic protein Osteopontin Leptin Osteomalacia Sevelamer Lanthium Sodium thiosulfate Cinacalcet 



25-Hydroxyvitamin D3 (also known as: 25-hydroxycholecalciferol, calcifediol, or calcidiol)


1,25-Dihydroxyvitamin D3 (also known as: 1,25-dihydroxycholecalciferol or calcitriol)


Apolipoprotein E


Bone morphogenic protein


Chronic kidney disease


Chronic kidney disease-mineral and bone disorder (also known as: renal osteodystrophy)


Epidermal growth factor receptors


End-stage renal disease


Fibroblast growth factor-23



IL-1, IL-6

Interleukin-1 and -6


Low-density lipoprotein


Matrix Gla protein






Parathyroid hormone (also known as: parathormone or parathyrin)


Transforming growth factor-alpha


Transforming growth factor-beta


Tumor necrosis factor-alpha


Uncarboxylated matrix Gla protein


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Nephrology and HypertensionGeorgetown University Medical CenterWashingtonUSA
  2. 2.Department of Medicine, Section of NephrologyUniversity of Illinois at Chicago College of MedicineBerwynUSA

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