SYNDROM KALCIFYLAXE JAKO KOMPLIKACECHRONICKÉHO SELHÁNÍ LEDVINPopis šesti kasuistik a literární přehled

Calciphylaxis as a Complication of the Chronic Renal Failure -Description of Six Causes and a Review

Calciphylaxis is a rate complication of unknown pathogenesis in patients with end stage renal disease. It ischaracterized by calcification of tunica media of small arteries associated with intimal fibrosis and thrombus formationwhich leads to the development of skin and subcutaneous tissue necrosis. Superinfection of skin lesions is a commonconsequence of this syndrome which may lead to the sepsis. The prognosis of this condition in serious. We performeda retrospective study of 6 subjects (4 men and 2 women) in the age of 35 to 59 years. We followed the parametersof calcium-phosphate metabolism, presence of calciphylaxis risk factors and the effect of parathyreoidectomy. Fivepatients were on hemodialysis, one had a kidney transplant. Skin and subcutaneous tissue necrosis were present inall subjects. The serum levels of parathormone were either high, normal or low, levels of calcium were normal orsliyhtly elevated and phosphate levels were high or normal. Calcium was substituted before calciphylaxis develop-ment in 5 patients, calcitriole in 3 of therm. Five patients underwent parathyroidectomy. Three patients died (all ofsepsis), one patient had the lower into amputation for infected lesions and the remaining two achieved regression.Our findings do support the hypothesis that calcium and calcitriole administration participates in development ofcalciphylaxis. Fatal prognosis of the once infections skin lesions was also proved.

Key words:
calciphylaxis, end stage renal disease, calcium-phosphate metabolism.