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Calciphylaxis — ESENeph MCQ

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HardRenal Bone Disease and Renal AnaemiaCalciphylaxisESENeph

A 61-year-old woman on haemodialysis develops exquisitely painful retiform purpura on her thighs. She takes warfarin for atrial fibrillation; corrected calcium is 2.52 mmol/L and phosphate is 2.3 mmol/L. Skin biopsy confirms vascular calcification with thrombosis. What is the most likely diagnosis?

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Correct answer: B — Calciphylaxis

Painful necrotic retiform skin lesions with biopsy-proven calcification in a dialysis patient are typical of calciphylaxis. Warfarin, hyperphosphataemia and dialysis are recognised risk factors. Cholesterol embolisation causes livedo and eosinophilia after vascular procedures but not the same calcific arteriolopathy. The pearl is that management is multidisciplinary and includes wound care, analgesia, infection control and correction of calcium-phosphate imbalance.

Reference: UKKA CKD-MBD guidance; KDIGO CKD-MBD Guideline