Endocrine Abstracts

Introduction: Calcific Uremic Arteriolopathy (CUA) is a rare but severe complication of end-stage kidney disease with one year survival rates between 45-55%. Extensive skin ulcers and concomitant painful purpura are the clinical features and diagnosis criteria as defined by Hayashi. Parathyroidectomy treatment for hyperparatiroidism is reserved for patients with inadequate response to calcimimetics, persistent elevated PTH>800 pg/ml or calciphylaxis and it has been shown to provide benefits for all-cause mortality in secondary hyperparathyroidism patients.

Method: Case series of five patients (3 females and 2 males) with a mean age of 51± 5.3 years old with end stage kidney disease and hemodialysis programme duration of 9.5± 2.7 years. Due to persistent high serum iPTH levels was 1400± 270 pg/ml after calcimimetics medication, sub -total parathyroidectomy was indicated in all 5 cases. We evaluated calciphylaxis lessions and iPTH dynamic levels for the next 12 months.

Results: CUA with painfull skin ulcers has occurred in 2 cases, the patients aged 46 and 49 years old, males and with a hemodialysis history of 8 respectively 11 years. The iPTH levels before parathyroidectomy were >1400 pg/ml in both cases, and they had severe post-surgery hypocalcemia 1.48 mmol/l and 1.53 mmol/l with iPTH levels between 120 and 250 pg/ml. The outcome after surgical debridation, antibiotherapy, discontinuation of anti-vitamin K and nutritional support was favorable with complete skin ulcers remission and stable calcium levels of 1.8-2.1 mmol/l.

Conclusions: The calciphylaxis lessions are rare, especially after parathyroidectomy, when calcium levels are lower and iPTH levels are reduced. Guidelines for CUA therapy are currently lacking and these particular cases show that long term evolution of hyperparathyroidism especially with very high levels of PTH need accurate management. Also the associated severe hypocalcemia is an aggravating factor, as correction with calcium supplements may lead to calciphylaxis lesion progression.