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A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome
- Source :
- Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 156(3)
- Publication Year :
- 2011
-
Abstract
- Background: Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results: A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the onset of haemolytic uremic syndrome, underwent a kidney transplant in April 2008. After transplantation there was a recurrence of the haemolytic uremic syndrome, with temporary worsening of the graft. Six months later there was a definite loss of graft and return to dialysis treatment. On April 2010 a severe systemic calciphylaxis related to secondary hyperparathyroidism was diagnosed. The patient underwent parathyroidectomy but, because of the unimproved clinical picture, treatment with sodium thiosulphate was initiated. There was only improvement in cutaneous lesions. The worsening general clinical condition of the patient caused death due to general septic complications. Conclusions: The coexistence of haemolytic uremic syndrome and secondary hyperpathyroidism makes the prognosis poor and, in this case, therapy, which counteracts calcium crystals precipitation, has no effect. Preventive parathy­roidectomy can be considered as the only possible treatment.
- Subjects :
- Parathyroidectomy
Graft Rejection
medicine.medical_specialty
medicine.medical_treatment
Calciphylaxi
Settore MED/08 - Anatomia Patologica
General Biochemistry, Genetics and Molecular Biology
End stage renal disease
Fatal Outcome
Secondary hyperparathyroidism
Calciphylaxis
Kidney transplant
medicine
Humans
Dialysis
Settore MED/14 - Nefrologia
Hyperparathyroidism
business.industry
Middle Aged
medicine.disease
Kidney Transplantation
Surgery
Transplantation
Settore MED/18 - Chirurgia Generale
Hemolytic-Uremic Syndrome
Kidney Failure, Chronic
Female
Hyperparathyroidism, Secondary
Complication
business
Subjects
Details
- ISSN :
- 18047521
- Volume :
- 156
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
- Accession number :
- edsair.doi.dedup.....113008de7815b0631ace7b081470473c