Wednesday, August 1, 2018

Topic Discussion: Non-nephrogenic calciphylaxis

Calciphylaxis in Patients With Normal Renal Function is usually unusual as most of the cases we encounter as nephrologists are in ESRD and or CKD patients
A recent review and literature update by the MGH researchers defined concomitant risk factors, treatment, and outcomes for patients with nonnephrogenic calciphylaxis.
116 patients today were reviewed.  Vitamin K antagonism and obesity were the most common concomitant factors. In the literature review, lower age and higher body mass index  were associated with the central location of lesions, whereas vitamin K antagonism was associated with the peripheral locations.  None of the treatments were associated with lesion improvement or survival.
As summarized by the authors: the risk factors are the 4Ws:- Warfarin, White race, Women and overWeight in patients with normal renal function. Interesting that warfarin is a risk factor in both renal and non renal calciphylaxis. It’s perhaps about time the renal community embrace apixaban over warfarin
A larger set of risk factors exists that were mentioned in the recent NEJM review in 2018 that also add: ESRD( what we see), hypercalcemia( probably in setting of CKD as pure – not really evident), DMII, hyperparathyroidism( we have seen this), Vitamin K deficiency, Autoimmune disorders, metastatic cancers, rapid weight loss, skin trauma to name a few.
Check out this interesting tweetorial from ISN education on this topic

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