Sandhu Gagangeet, Casares Pablo, Ranade Aditi, Jones James, Amar Levy I S, Guisado Daniela, Chan Germaine, Smith Steven D
Clin Nephrol. 2013 Oct;80(4):301-5. doi: 10.5414/CN107524.
Calciphylaxis, or calcific uremic arteriopathy (CUA), is characterized by metastatic calcification in the media of small arteries and arterioles leading to cutaneous necrosis. It is most commonly seen in patients with end stage renal disease who have elevated serum calcium × phosphorus (Ca × P) product. Normalization of Ca × P product is considered paramount in the prevention and treatment of CUA. We describe a novel presentation of CUA in which a Stage-5 CKD patient developed signs and symptoms of CUA immediately after initiation of hemodialysis (HD). We postulate that an influx of calcium from the dialysate into the patient's blood, in addition to correction of her acidosis, led to abundant substrate in a favorable milieu for Ca-P complex formation at the time of her first HD session. Our case is the first reported case of HD associated iatrogenic acute CUA. To avoid this complication, we should maintain adequate hydration,use lower calcium dialysate, and avoid vitamin D analogues and calcium-containing medications when initiating HD in patients with high Ca-P product. Since sodium thiosulfate is known to prevent precipitation of Ca-P complexes, its empiric use during initial HD treatments may be effective in preventing CUA, a potentially fatal disease.
钙敏性血管病变，即钙化性尿毒症性动脉病（CUA），其特征是小动脉和小动脉中层发生转移性钙化，进而导致皮肤坏死。它最常见于血清钙×磷（Ca×P）乘积升高的终末期肾病患者。Ca×P乘积的正常化被认为是预防和治疗CUA的关键。我们描述了CUA的一种新表现形式，一名5期慢性肾脏病患者在开始血液透析（HD）后立即出现了CUA的体征和症状。我们推测，除了纠正酸中毒外，透析液中的钙流入患者血液，在其首次HD治疗时，为Ca-P复合物的形成提供了丰富的底物和有利的环境。我们的病例是首例报道的与HD相关的医源性急性CUA病例。为避免这种并发症，对于Ca-P乘积高的患者，在开始HD时，我们应保持充足的水化，使用低钙透析液，并避免使用维生素D类似物和含钙药物。由于已知硫代硫酸钠可防止Ca-P复合物沉淀，在初始HD治疗期间经验性使用它可能有效预防CUA，这是一种潜在致命的疾病。
