Mohamed Omer1, Zeenat Yousuf Bhat2, Nanette Fonte3, Nashat Imran2, James Sondheimer2, Yahya Osman-Malik2. 1. Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA. 2. Division of Nephrology and Hypertension, Wayne State University, Detroit Medical Center, Detroit, USA. 3. Antelope Valley Nephrology Medical Group, Lancaster, California, USA.
Abstract
MATERIALS AND METHODS: 24 patients with CUA and on RRT were evaluated at Detroit Medical Center from 2007 to 2016. Skin biopsy was used in almost all patients, along with the radiological and clinical findings. The patient's clinical and paraclinical data were retrieved from the electronic medical records. The effect of treatment modalities and the underlying hyperparathyroidism management were compared to the clinical outcomes using appropriate statistical tests. RESULTS: Twenty-one patients were on hemodialysis, two patients received renal transplants, and one patient was on peritoneal dialysis. Diabetes mellitus was the most prevalent cause of ESRD. The parathyroid hormone level (PTH) was elevated in 22 patients. Fifteen patients were diagnosed 2 weeks or more prior to skin lesion onset. Twenty-two and thirteen patients received sodium thiosulphate and cinacalcet, respectively. Patients with lower PTH and the calcium-phosphate product levels had a relatively better outcome of CUA. CONCLUSIONS: A multifaceted approach may play a role in treating CUA. Referral to a nephrologist may aid in the early diagnosis and prompt management of CUA.
MATERIALS AND METHODS: 24 patients with CUA and on RRT were evaluated at Detroit Medical Center from 2007 to 2016. Skin biopsy was used in almost all patients, along with the radiological and clinical findings. The patient's clinical and paraclinical data were retrieved from the electronic medical records. The effect of treatment modalities and the underlying hyperparathyroidism management were compared to the clinical outcomes using appropriate statistical tests. RESULTS: Twenty-one patients were on hemodialysis, two patients received renal transplants, and one patient was on peritoneal dialysis. Diabetes mellitus was the most prevalent cause of ESRD. The parathyroid hormone level (PTH) was elevated in 22 patients. Fifteen patients were diagnosed 2 weeks or more prior to skin lesion onset. Twenty-two and thirteen patients received sodium thiosulphate and cinacalcet, respectively. Patients with lower PTH and the calcium-phosphate product levels had a relatively better outcome of CUA. CONCLUSIONS: A multifaceted approach may play a role in treating CUA. Referral to a nephrologist may aid in the early diagnosis and prompt management of CUA.
Authors: James T McCarthy; Rokea A El-Azhary; Michelle T Patzelt; Amy L Weaver; Robert C Albright; Alina D Bridges; Paul L Claus; Mark D P Davis; John J Dillon; Ziad M El-Zoghby; LaTonya J Hickson; Rajiv Kumar; Robert D McBane; Kathleen A M McCarthy-Fruin; Marian T McEvoy; Mark R Pittelkow; David A Wetter; Amy W Williams Journal: Mayo Clin Proc Date: 2016-10 Impact factor: 7.616