SHM Converge Scientific Abstract ePoster Gallery-Got Milk?: Calcium Dysregulation in Patients With Esrd

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This case describes a 45-year-old woman with end-stage renal disease on hemodialysis, antiphospholipid syndrome treated with warfarin, and type 2 diabetes who presented with severe intermittent abdominal pain. Examination showed tender subcutaneous nodules in the lower abdomen with violaceous discoloration and central necrosis, raising concern for calciphylaxis. Laboratory findings showed elevated creatinine, phosphate, and parathyroid hormone levels, with calcium at the upper end of normal and an INR of 2.3. Skin biopsy demonstrated necrotic dermal tissue with a vasculopathic reaction, though without definitive intravascular calcification. CT imaging revealed hepatosplenomegaly but no acute abdominal process.<br /><br />The patient was managed with extensive wound care, sodium thiosulfate infusions during hemodialysis, multimodal pain control, and mineral-bone disorder optimization by switching from calcium acetate to sevelamer carbonate. Because warfarin is a known risk factor for calciphylaxis, anticoagulation was changed from warfarin to apixaban.<br /><br />The discussion emphasizes that calciphylaxis, also called calcemic uremic arteriolopathy, is a painful and frequently under-recognized disease associated with very high one-year mortality, reported at 45% to 80%. This patient had several major risk factors, including ESRD, calcium supplementation, warfarin use, and morbid obesity. The case highlights the importance of early multidisciplinary care involving dermatology for biopsy consideration, hematology for anticoagulation decisions, nephrology for calcium/phosphate management, and wound/palliative care for symptom relief and source control. Despite appropriate treatment, prognosis remains poor.

Asset Subtitle

Vineet Gupta

Meta Tag

Author List Faizah Shareef, Farid Ghamsari, Rakesh Malhotra, Shawn Khrishnan, Vineet Gupta

Category Clinical Vignettes

Concept Calciphylaxis

Concept End-stage Kidney Disease

Concept Sodium Thiosulfate

Concept Necrosis

Concept Elevated Calcium-Phosphate Burden

Distinguished Non-Finalist

Presenter Organization University of California, San Diego (UCSD)

Presenting Author Vineet Gupta

Track Adult

Keywords

calciphylaxis

end-stage renal disease

hemodialysis

warfarin

antiphospholipid syndrome

sodium thiosulfate

skin biopsy

vasculopathic reaction

hyperphosphatemia

wound care

Calciphylaxis

End-stage Kidney Disease

Sodium Thiosulfate

Necrosis

Elevated Calcium-Phosphate Burden