Wilkinson S P, Stewart W K, Parham D M, Guthrie W
Department of Medicine, Ninewells Hospital and Medical School, Dundee.
Q J Med. 1988 Apr;67(252):319-41.
Medical calcification of arteries is common in chronic renal failure. We report on a patient with extensive calcification of the arterial media who developed symmetrical acral gangrene and severe cardiac failure shortly after cadaveric renal transplantation. At necropsy, the medial calcification was found to be accompanied by extensive intimal proliferation and multiple antemortem fractures, some healing by callus formation. Such medial calcification, which is similar to Monckeberg's sclerosis, affected all systemic arteries except the aorta, pulmonary artery and transplanted renal artery. Six years before this terminal illness he had undergone total parathyroidectomy for osteitis fibrosa associated with ruptured tendons. We review previous reports of patients with the syndrome of acral gangrene in azotaemic renal failure and discuss the histopathological features and pathogenesis in relation to the unusual features of our patient.
动脉的医学钙化在慢性肾衰竭中很常见。我们报告了一名患有广泛动脉中层钙化的患者，该患者在尸体肾移植后不久出现对称性肢端坏疽和严重心力衰竭。尸检时发现，中层钙化伴有广泛的内膜增生和多处生前骨折，有些骨折通过骨痂形成愈合。这种与蒙克贝格硬化症相似的中层钙化累及除主动脉、肺动脉和移植肾动脉外的所有全身动脉。在这场终末期疾病发生的六年前，他因与肌腱断裂相关的纤维性骨炎接受了甲状旁腺全切术。我们回顾了以往关于氮质血症性肾衰竭患者肢端坏疽综合征的报告，并结合我们患者的不寻常特征讨论了组织病理学特征和发病机制。
