Calciphylaxis

Diagnosis

Diagnosing calciphylaxis typically involves a comprehensive evaluation of symptoms, a thorough examination of one’s medical history, and a physical assessment to detect any changes in the skin or underlying tissue.

These tests may be ordered to help with the diagnosis:

• Lab tests: Blood and urine tests play a crucial role in diagnosing and assessing the severity of calciphylaxis. Blood samples analyze an array of compounds present in your bloodstream, including but not limited to calcium, phosphorus, parathyroid hormone, abnormalities in blood-clotting components, aluminum levels, urea nitrogen, creatinine, and albumin, among others. These measurements aid your healthcare provider in evaluating the functioning of your kidneys and liver.
• Imaging test: Vascular calcifications, or branch-like calcium deposits in the blood vessels, are frequently observed in severe kidney diseases and calciphylaxis can be seen on X-rays.
• Skin biopsy: A skin sample is usually obtained from the perimeter of a lesion or wound, typically around 4 or 5 millimeters deep. Analysis of the sample involves microscopic examination and the application of specific substances to induce color or chemical alterations, aiding in the definitive confirmation of the diagnosis.

Treatment

Currently, there is no known cure for calciphylaxis, but effective treatment approaches can help induce a state of remission. Recommended treatment options may encompass:

• Intensive wound care: The primary focus is on preventing infection and facilitating wound healing. Medication may be prescribed to manage pain associated with calciphylaxis or during the process of wound care. Antibiotics are utilized as part of the treatment to prevent and address wound infections.
  To promote the healing of sores, surgical removal or debridement of damaged tissue affected by calciphylaxis may be necessary. Alternatively, other methods like wet dressings could be employed for tissue removal.
• Increasing blood flow and oxygen to the skin: Hyperbaric oxygen therapy entails placing the individual in a sealed chamber with 100% oxygen at a slightly higher pressure than usual, compared to the normal 20% oxygen concentration. This method is highly effective in promoting the healing of wounds.
  Administering low-dose tissue plasminogen activator (TPA) may help disintegrate blood clots in the skin’s tiny blood vessels. In order to restore blood flow to injured tissues, anticoagulant medicine, such as apixaban, may be prescribed to help prevent blood clots.
• Reducing calcium deposits
  • Taking medications: Cinacalcet, a drug that helps regulate parathyroid hormone (PTH), may be suggested. Sodium thiosulfate, a medicine that helps reduce the accumulation of calcium in the arterioles, may be administered thrice a week, typically during dialysis. The calcium and phosphorus balance can also be improved by taking additional drugs.
  • Modifying medications: The dosage of any calcium or vitamin D supplements may be adjusted if it can potentially cause calciphylaxis. To eliminate any substances that could trigger calciphylaxis, such as iron, corticosteroids, or warfarin, the healthcare provider will review all medications one is taking.
  • Dialysis: In the case of individuals undergoing kidney dialysis, adjustments to the dialysis prescription, including modifications to the medications utilized and the frequency of the dialysis sessions may be required.
  • Surgery: Surgical excision of all or a portion of the parathyroid glands may be advised if an excessive production of parathyroid hormone or hyperparathyroidism leads to aberrant calcium metabolism.