Progressive vascular calcification with necrosis of extremities in hemodialysis patients: a possible role of iron overload |
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| Authors: | D Rubinger M M Friedlaender J Silver Y Kopolovic W J Czaczkes M M Popovtzer |
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| Affiliation: | 1. Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA;2. Research Institute, Hospital for Special Surgery, New York, New York, USA;3. Division of Pediatric Nephrology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA;4. Clinical and Translational Science Center, Weill Cornell Medicine, New York, New York, USA;5. Division of Endocrinology, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA;6. Cell and Molecular Biology Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania, USA;7. Division of Hematology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;8. NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York, USA;1. Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Nanjing University of Chinese Medicine, Nanjing 210023, China;2. National Key Laboratory of Pharmaceutical New Technology for Chinese Medicine, Jiangsu Kanion Pharmaceutical Co. Ltd., Lianyungang 222001, China;1. Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington;2. Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas;3. Michael E. DeBakey Veterans Affairs Hospital, Houston, Texas;4. Benjamin Leon Center for Geriatric Research and Education, Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida;5. Department of Pathology, School of Medicine, University of Maryland, Baltimore, Maryland;6. Division of Nephrology, School of Medicine, University of Maryland, Baltimore, Maryland;7. Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;8. Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia;9. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;10. Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;11. Division of Cardiovascular Medicine, Department of Medicine, and Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California;12. Division of Research, Kaiser Permanente Northern California, Oakland, California;13. Tulane University Translational Science Institute, Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana;14. Department of Medicine, and Department of Epidemiology and Biostatistics, University of California-San Francisco, and San Francisco VA Medical Center, San Francisco, California;15. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;1. Department of Nephrology, Gojinkai-Sumiyoshigawa Hospital, Japan;2. Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Japan;1. School of Geography and Earth Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada;2. Department of Materials Science and Engineering, Canadian Centre for Electron Microscopy, McMaster University, Hamilton, ON L8S 4K1, Canada |
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| Abstract: | Progressive vascular calcification with ischemia and gangrene of the extremities occurs rarely in uremic patients, patients undergoing maintenance dialysis, and following renal transplantation. In this paper we present two additional patients on chronic hemodialysis who developed this syndrome in association with severe secondary hyperparathyroidism. Fulminant gangrene led to the death of the first patient, while in the second, multiple amputations had to be performed after parathyroidectomy. In both patients, evidence of iron overload due to multiple blood transfusions was present and iron was histologically demonstrated in a calcification area in one case. The possibility of iron overload as a "challenger" for systemic calciphylaxis is discussed. |
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