Eleven patients 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 three. Five patients required maintenance hemodialysis; six had functioning renal homografts. Severe hyperphosphatemia had existed in each; seven showed roentgenographic evidence of subperiosteal resorption. Similarities are 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 ten of 11 patients undergoing surgical procedures; healing followed in seven 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.
(Arch Intern Med 136:1273-1280, 1976)
Gipstein RM, Coburn JW, Adams DA, et al. Calciphylaxis in Man: A Syndrome of Tissue Necrosis and Vascular Calcification in 11 Patients With Chronic Renal Failure. Arch Intern Med. 1976;136(11):1273–1280. doi:10.1001/archinte.1976.03630110043012
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