More common in patients with end-stage renal disease, also known as calcium-uremic arteriolopathy

Definition: An extremely painful ischemic skin and soft tissue lesion due to microvascular calcification and thrombosis in the dermis and subcutaneous adipose tissue.

pathology

high risk factors

Early stage: skin hardening, plaques, nodules, livedo reticularis or purpura

In the middle and late stages: the skin darkens and forms necrotic ulcers, accompanied by black eschar.

Proposed diagnosis: 2 main factors, early suspicious skin changes; 1 main factor, 3 secondary factors, early suspicious skin changes

Clinical diagnosis: 1 high-risk factor, typical skin lesions, exclusion of other diseases

Confirmed diagnosis: Positive skin biopsy High-risk factors Skin lesions Exclude other diseases

Main factors: application of warfarin, application of large-dose calcium-phosphorus binders, active vitamin D dose greater than 0.5ug/d, serum protein C or protein S deficiency, vitamin K deficiency, IPTH greater than 1000pg/ml

Secondary factors: dialysis for more than 5 years, obesity, diabetes, hypoalbuminemia, use of immunosuppressants and glucocorticoids, IPTH greater than 300pg/ml (less than 1000)

Early suspicious skin lesions: intractable itching, rough skin, hypoesthesia or hypersensitivity, diffuse nodular changes, accompanied by itching, pain and rash-like changes

Typical skin lesions: painful papules, sclerotic plaques, reticular livedo, necrotic skin ulcers, often accompanied by severe pain.

SOP for diagnosis and treatment of calciphylaxis in dialysis patients

Treatment status: There is a lack of specific treatment methods, and close cooperation between multiple disciplines is needed for comprehensive treatment.

1. Reduce or remove triggers

2. Pain Management

3. Wound care

4. Medication

5. Hyperbaric oxygen therapy

Calciphylaxis is a rare, fatal disease.

Research on early diagnosis and treatment strategies has broad prospects

Improved imaging technology and precise treatment based on mechanism research are important directions for future calciphylaxis treatment research.