Dr Sadia Jahan1, Dr Arvinf Rajandran1, Dr Lucy McKinnon1, Dr Nur Fariszah Baharuddin1, Dr Maleeka Ladhani1, A/Prof Nitesh Rao1
1Renal Unit, Lyell McEwin Hospital, Adelaide, 5000
Background
Calciphylaxis can be categorised into uremic, classically seen in patients with end stage kidney disease (ESKD) and non-uremic, which is calciphylaxis in patients with normal renal function or early stages of kidney disease. The latter is associated with a 1-year mortality between 25-50%.
Case Report
We present a 63-year-old female of Caucasian background with the primary disease of familial glomerulonephritis. She had haemodialysis for 10 years prior to transplantation in 1990 (31 years ago).
She had a baseline creatinine between 150-250umol/L and her transplant was managed with tacrolimus, azathioprine and prednisolone. Of note she had previously had a total parathyroidectomy prior to transplantation.
She presented with multiple necrotic, extremely painful indurated lesions over shins, calves and buttocks, with some areas of eschar. This coincided with delirium in the context of hypercalcaemia (corrected calcium of 3.26mmol/L). Renal function deteriorated with a creatinine peak to 300umol/L. She had normal phosphate (0.84mmol/L) and PTH (0.9pmol/L). Biopsy of the lesions returned with small arteriolar vessels with coarse calcification within their walls, in keeping with calciphylaxis.
Warfarin (for stroke prevention in the setting of atrial fibrillation) and calcium supplement was ceased and dialysis commenced with supplemental sodium thiosulphate. Despite maximal treatment, the necrotic lesions continued to progress in size and subcutaneous nodules increased in number leading to a bed bound state. She was transitioned to comfort care within 3 weeks post re-commencement of dialysis to optimise biochemistry.
Conclusion
Calciphylaxis is associated with a high mortality rate, including patients with renal transplantation.
Biography:
Bio to come