Calciphylaxis in
Patients With Normal Renal Function is usually unusual as most of the cases we
encounter as nephrologists are in ESRD and or CKD patients
A
recent review and literature update by the MGH researchers defined
concomitant risk factors, treatment, and outcomes for patients with
nonnephrogenic calciphylaxis.
116 patients today were reviewed. Vitamin K antagonism and obesity were the most
common concomitant factors. In the literature review, lower age and higher body mass index were associated with the central location of lesions,
whereas vitamin K antagonism was associated with the peripheral locations. None of the
treatments were associated with lesion improvement or survival.
As summarized by the authors: the risk
factors are the 4Ws:- Warfarin, White race, Women and overWeight in patients
with normal renal function. Interesting that warfarin is a risk factor in both
renal and non renal calciphylaxis. It’s perhaps about time the renal community embrace
apixaban over warfarin
A larger set of risk factors exists that were
mentioned in the recent NEJM review in 2018 that also add: ESRD( what we see),
hypercalcemia( probably in setting of CKD as pure – not really evident), DMII,
hyperparathyroidism( we have seen this), Vitamin K deficiency, Autoimmune
disorders, metastatic cancers, rapid weight loss, skin trauma to name a few.
Check out this interesting tweetorial from ISN
education on this topic
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