Calciphylaxis Following Parathyroidectomy in Chronic Kidney Disease Patients—Case Report and Literature Review
Abstract
1. Introduction
2. Case Report
3. Literature Review
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CUA | calcific uremic arteriopathy |
CKD | chronic kidney disease |
KTR | kidney transplant recipient |
HD | hemodialysis |
PTx | parathyroidectomy |
PTH | parathormone |
Ca | calcium |
P | phosphate |
MGP | matrix G1a protein |
ESRD | end-stage renal disease |
RRT | renal replacement therapy |
CKD-MBD | chronic kidney disease-mineral bone disorder |
DXA | dual X-ray absorptiometry |
BMD-DXA | bone mineral density-dual X-ray absorptiometry |
BMP | bone morphogenetic protein |
iPTH | intact parathormone |
DM | diabetes mellitus |
SHPT | secondary hyperparathyroidism |
STS | sodium thiosulfate |
NKF-KDOQI | National Kidney Foundation-Kidney Disease Outcomes Quality Initiative |
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BMD-DXA | L1-L4 Z-Score | Femoral Neck Z-Score | Forearm Z-Score |
---|---|---|---|
2021 | −1.4 | −1.8 | NA 1 |
2024 | −1.3 | −0.7 | −5.8 |
Author | M/F | Age (y) | Type of RRT | HD/Pdvintage | PTx Indication | Pre-PTx PTH (pg/mL) | Type of PTx | Post-PTx PTH (pg/mL) | Distribution of the Lesions | Time After PTx | Diagnostic Methods | Risk Factors | Therapeutic Approach After PTx |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Poch et al., 1992 [15] | M | 62 | HD | 8 y | SHPT, severe signs of osteodystrophy | 1205 | Subtotal PTx | 213 | Distal lower and upper extremities | 3 mo | Skin biopsy | Autoimmune conditions, prolonged application of topical therapies for psoriasis; deficiency of protein C; calcium supplementation for hypocalcemia | Calcitriol; calcium supplements; topical treatment for psoriatic lesions; transferred to PD 3 months later |
Oikawa et al., 2004 [16] | M | 32 | PD-HD | 13 y | SHPT | Unknown | PTx (not specified) | 63 during the onset of symptoms | Back, lower abdominal wall, lower extremities, penile and scrotal involvement | 2 y | Skin biopsy; X-ray; 99mTc-methylene disphosphonate; CT scan | Obesity followed by marked weight loss, corticosteroid medication | Hyperbaric oxygen for whole body; prostaglandin E1; continuous hemodiafiltration and endotoxin absorption; antibiotics; catecholamines; analgesics and narcotics |
Matstusoka et al., 2005 [17] | F | 57 | HD | 24 y | SHPT | Unknown | Total PTx with forearm autograft | 120 | Lower extremities | Unknown | Skin biopsy | Unknown | Medical and dermatological treatment |
M | 42 | HD | 15 y | SHPT | Unknown | Total PTx with forearm autograft | 705 | Trunk and extremities | 3 y | Skin biopsy | Unknown | Low calcium dialysate, calcitonin agent, bisphosphonates | |
F | 48 | HD | 16 y | SHPT | Unknown | Total PTx with forearm autograft | 180 | Lower extremities | Unknown | Skin biopsy | Unknown | Medical and dermatological treatment | |
Bonilla et al., 2007 [18] | F | 59 | HD | unknown | Calciphylaxis | Unknown | Subtotal PTx | Unknown | Breast | Unknown | Skin biopsy | Anticoagulation (specific type not mentioned) | Fine-needle aspiration; total mastectomy (because of the nonhealing wound and severe breast pain); another PTx |
Wahab et al., 2008 [13] | M | 33 | HD | 9 y | SHPT | 3489 | Subtotal PTx | 47 | Distal lower extremities | 7 w | Skin biopsy | Unknown | Dermatological treatment, antibiotics, skin grafting |
Katikaneni et al., 2013 [19] | F | 62 | HD | 5 y | Calciphylaxis | 1513 | Subtotal PTx | 406 | Breast, thigh, and lower abdominal wall | 16 mo | Skin biopsy | Obesity; DM2; calciphylaxis prior to PTx, calcium supplementation and vitamin D analog for hypocalcemia | 25 g of STS 3 times weekly; high calcium dialysate, sevelamer carbonate |
Bashir et al., 2016 [20] | M | 46 | HD | 14 y | SHPT, Pathological fractures | 2000 | Subtotal PTx | 891 | Penile | 2 w | CT scan | Calcium supplementation and vitamin D analog for hypocalcemia | Low calcium dialysate; high dose of sevelamer; local antibiotic; traditional treatment (honey, local herbs) |
Karmegam and Shetty, 2017 [21] | M | 60 | HD | 2.5 y | HPT and osteopenia | 4191 | Subtotal PTx | 184 | Lower extremity and buttocks | 4 w | Skin biopsy | DM2, prednisone usage for pain relief | Wound care; antibiotics; increased duration of HD session; 25 g STS with all HD sessions; high-dose oral calcium and vitamin D supplements; oral opiods, topical lidocaine, gabapentine; prednisone |
Sanha et al., 2023 [8] | F | 26 | HD | 4 y | Brown tumor due to SHPT | >2000 | Total PTx with forearm autograft | 43 (on the first postoperative day), 118 (4 weeks later) | Distal lower extremities | 3 w | Clinical diagnosis (negative early biopsy) | No risk factors mentioned | Wound care; pain management; antibiotics, STS |
Hristov et al., 2023 [22] | M | 46 | HD | 8 y | SHPT | >1400 | Subtotal PTx | values of 120–250 | Unknown | Unknown | Unknown | Unknown | Surgical debridement; antibiotics; discontinuation of anti-vitamin K; nutritional support |
M | 49 | HD | 11 y | SHPT | >1400 | Subtotal PTx | values of 120–250 | Unknown | Unknown | Unknown | Unknown | Surgical debridment; antibiotics; discontinuation of anti-vitamin K; nutritional support | |
Smith et al., 2023 [2] | F | 60 | KTx | 7 y | SHPT | 396 | Total PTx | <9 | Left lower leg | 3 y | Histopathology | DM, anticoagulation with anti-vitamin K | Limb amputation; STS, discotinuation of anti-vitamin K; vitamin K2 supplementation |
Our study, 2024 | M | 36 | HD-DP-HD | 16 y | SHPT | 2100 | Total PTx | 330 | Distal upper extremities | 8 w | Clinical diagnosis | Calcium supplementation and vitamin D analog for hypocalcemia | Discontinuation of calcium supplementation |
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Akad, N.; Bilha, S.C.; Apetrii, M.; Akad, F.; Bilha, M.; Hogas, M.; Hogas, S.; Ungureanu, M.-C.; Preda, C.; Covic, A. Calciphylaxis Following Parathyroidectomy in Chronic Kidney Disease Patients—Case Report and Literature Review. Biomedicines 2025, 13, 715. https://doi.org/10.3390/biomedicines13030715
Akad N, Bilha SC, Apetrii M, Akad F, Bilha M, Hogas M, Hogas S, Ungureanu M-C, Preda C, Covic A. Calciphylaxis Following Parathyroidectomy in Chronic Kidney Disease Patients—Case Report and Literature Review. Biomedicines. 2025; 13(3):715. https://doi.org/10.3390/biomedicines13030715
Chicago/Turabian StyleAkad, Nada, Stefana Catalina Bilha, Mugurel Apetrii, Fawzy Akad, Madalina Bilha, Mihai Hogas, Simona Hogas, Maria-Christina Ungureanu, Cristina Preda, and Adrian Covic. 2025. "Calciphylaxis Following Parathyroidectomy in Chronic Kidney Disease Patients—Case Report and Literature Review" Biomedicines 13, no. 3: 715. https://doi.org/10.3390/biomedicines13030715
APA StyleAkad, N., Bilha, S. C., Apetrii, M., Akad, F., Bilha, M., Hogas, M., Hogas, S., Ungureanu, M.-C., Preda, C., & Covic, A. (2025). Calciphylaxis Following Parathyroidectomy in Chronic Kidney Disease Patients—Case Report and Literature Review. Biomedicines, 13(3), 715. https://doi.org/10.3390/biomedicines13030715