Abstract: TH-PO177
Successful Treatment Using Oral Vitamin K in a Patient on Peritoneal Dialysis with an Extensive Right Hip Lesion Due to Calcific Uremic Arteriolopathy (CUA, Calciphylaxis): A Rare but Highly Fatal Condition
Session Information
- CKD-MBD: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Mal, Niladri, Munson Healthcare Cadillac Hospital, Cadillac, Michigan, United States
- Ali, Arshad, Munson Healthcare Cadillac Hospital, Cadillac, Michigan, United States
- Chowdhury, Shoaib A., Munson Healthcare Cadillac Hospital, Cadillac, Michigan, United States
Group or Team Name
- Munson Healthcare.
Introduction
Calciphylaxis is a rare but serious disorder commonly seen in patients with end-stage renal disease, however, rarely occurs in patients with normal renal function, acute renal failure or earlier stages of chronic kidney disease (non-uremic CAU). CAU typically present as painful skin lesion as results from calcification of the medial layer of arterioles and small arteries leads to tissue ischemia and infraction, a fatal condition with one-year mortality upto 30-80%, mostly due to sepsis.
Case Description
73 y old Female on peritoneal dialysis who presented with severe progressive calciphylaxis on her right thigh. Patient was intolerant to sodium thiosulfate therapy. The patient was given high dose ( 100 x of daily requirements) Vit K therapy 10 mg on Mon-Wed-Fri for 6 months, which was the principal therapy, resulted in skin healing and complete resolution of the CUA (Fig 1). Hence, CAU is a rare, fatal condition that requires prompt diagnosis and treatment and should be suspected in a dialysis patient with painful skin lesion. Although previous study shows poor effectiveness of Vitamin K therapy, our study for the first time strongly validates effectiveness of high dose Vit K therapy in treating calciphylaxis in peritoneal dialysis patients.
Discussion
Matrix G1a protein which is dependent on Vit K dependent carboxylation for its activity, may prevent vascular calcification [(1) Dobry AS]. Therefore, Warfarin use has been implicated as a risk factor for calciphylaxis and Vit K therapy has potential in treatment of calciphylaxis. In our patient, we successfully able to diagnose her early and treat her with Vit K supplement, resulted in her rapid pain relief, wound healing, and prevention of death.
Fig 1. Shows an extensive necrotic ulcer in right thigh due to calciphylaxis (left image) and complete wound healing after completion of Vit K therapy for six months (right image).