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Calcific Uremic Arteriolopathy (Calciphylaxis)

  • Earl H. Rudolph
  • Edgar V. Lerma
Chapter

Abstract

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.

Keywords

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 

Abbreviations

25-(OH)D3

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

1,25-(OH2)D3

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

ApoE

Apolipoprotein E

BMP

Bone morphogenic protein

CKD

Chronic kidney disease

CKD-MBD

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

EGFRs

Epidermal growth factor receptors

ESRD

End-stage renal disease

FGF-23

Fibroblast growth factor-23

HPT

Hyperparathyroidism

IL-1, IL-6

Interleukin-1 and -6

LDL

Low-density lipoprotein

MGP

Matrix Gla protein

OPG

Osteoprotegerin

OPN

Osteopontin

PTH

Parathyroid hormone (also known as: parathormone or parathyrin)

TGF-α

Transforming growth factor-alpha

TGF-β

Transforming growth factor-beta

TNF-α

Tumor necrosis factor-alpha

ucMGP

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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