569:(SLE). Calciphylaxis, regardless of etiology, has been reported at an incidence of 35 in 10,000 dialysis patients per year in the United States, 4 in 10,000 patients in Germany, and less than 1 in 10,000 patients in Japan. It is unknown whether the higher incidence in the United States is due to genuinely higher incidence or due to underreporting in other countries. Annual incidence in kidney transplant patients and in non-uremic calciphylaxis patients is also unknown. The median age of patients at diagnosis of calciphylaxis is 60 years and the majority of these patients are women (60-70%). The location of lesions, central (located on the trunk) or peripheral (located on the extremities), is dependent on several risk factors. Central lesions are associated with younger patients, patients with a higher
368:. Excisional biopsy should not be done due to increased risk of further ulceration and necrosis. Bone scintigraphy can be performed in cases where skin biopsy is contraindicated. Results of the study show increased tracer accumulation in the soft tissues. In certain patients, an anti-nuclear antibody test may play a role in diagnosis of calciphylaxis. Plain radiography and mammography may also show calcifications but these tests are less sensitive. Laboratory studies, such as phosphate levels, calcium levels, and parathyroid levels, are nonspecific and unhelpful for diagnosis of calciphylaxis.
478:(medication parathyroidectomy) is an oral medication that can be used to suppress the parathyroid glands for patients who may not be able to undergo surgical parathyroidectomy. Vitamin K supplementation has also been shown to slow development of calcification in coronary arteries and the aortic valve in older patients. The ability of vitamin K supplementation to slow calcification of blood vessels in calciphylaxis is not well-studied. Warfarin, a vitamin K antagonist discussed above, should be discontinued if possible.
386:
active metabolites that accumulate in the body of patients with kidney failure. Adjunct medications such as gabapentin and ketamine may also be used for analgesia. In refractory cases, spinal anesthetics (nerve blocks) can be used for more comprehensive pain relief. Wound care for calciphylaxis lesions involves using appropriate dressings, wound debridement (removal of dead tissue), and prevention of infection. Wound infections lead to
40:
315:
have been shown to calcify vascular smooth muscle cells when exposed to high phosphate levels in vitro, mediated by vascular endothelial growth factor A (VEGF-A) and leptin released by adipocytes. Given that calciphylaxis tends to affect adipose tissue, this may be a contributing explanation. Another
258:
in an ulcer with adherent black slough develops. Surrounding the ulcers is usually a plate-like area of indurated skin. These lesions are always extremely painful and most often occur on the lower extremities, abdomen, buttocks, and penis. Lesions are also commonly multiple and bilateral. Because the
527:
Overall, the clinical prognosis for calciphylaxis is poor. The 1-year mortality rate in patients who have end-stage kidney disease is 45-80%. Median survival in patients who do not have end-stage kidney disease is 4.2 months. Response to treatment is not guaranteed. The most common cause of death in
385:
Pain management and choice of analgesia is a challenging task in managing calciphylaxis. Pain is one of the most severe and pervasive symptoms of the disease and can be unresponsive to high-dose opioids. Fentanyl and methadone are preferred analgesics over morphine, since morphine breakdown produces
540:
Calciphylaxis most commonly occurs in patients with end-stage renal disease who are on hemodialysis or who have recently received a kidney transplant. When reported in patients without end-stage renal disease (such as in earlier stages of chronic kidney disease or in normal kidney function), it is
363:
There is no diagnostic test for calciphylaxis. The diagnosis is a clinical one. The characteristic lesions are the ischemic skin lesions (usually with areas of skin necrosis). The necrotic skin lesions (i.e. the dying or already dead skin areas) typically appear as violaceous (dark bluish purple)
1599:
McCarthy, James T.; el-Azhary, Rokea A.; Patzelt, Michelle T.; Weaver, Amy L.; Albright, Robert C.; Bridges, Alina D.; Claus, Paul L.; Davis, Mark D.P.; Dillon, John J.; El-Zoghby, Ziad M.; Hickson, LaTonya J.; Kumar, Rajiv; McBane, Robert D.; McCarthy-Fruin, Kathleen A.M.; McEvoy, Marian T.;
306:
reaction (i.e., allergic reaction) leading to sudden local calcification. The disease is also known as calcific uremic arteriolopathy; however, the disease is not limited to patients with kidney failure. The current belief is that in end-stage kidney disease, abnormal calcium and phosphate
407:, or simply dialysis, but the length or frequency of sessions may be increased. The majority of dialysis patients are on a 4-hour three times per week schedule. Indications for increasing dialysis session length or frequency include electrolyte and mineral abnormalities, such as
390:, which is one of the leading causes of death in patients with calciphylaxis. Surgical wound debridement carries increased risk for infection, so it should only be considered as therapy if the survival benefit outweighs the chances of continued wound non-healing and pain.
507:. Considering lowering the dose of or discontinuing the use of immunosuppressive drugs in people who have received kidney transplants and continue to have persistent or progressive calciphylactic skin lesions can contribute to an acceptable treatment of calciphylaxis.
324:(MGP), which in turn inhibits calcification. End-stage kidney disease patients are more likely to have vitamin K deficiency due to dietary restrictions meant to limit potassium and sodium. Many end-stage kidney disease patients are also on a medication called
364:
lesions and/or completely black leathery lesions. They can be extensive and found in multiples. The suspected diagnosis can be supported by a skin biopsy, usually a punch biopsy, which shows arterial calcification and occlusion in the absence of
311:. Once the calcium has been deposited, a thrombotic event occurs within the lumen of these vessels, resulting in occlusion of the vessel and subsequent tissue infarction. Specific triggers for either thrombotic or ischemic events are unknown.
1361:
Cai MM, Smith ER, Brumby C, McMahon LP, Holt SG (2013). "Fetuin-A-containing calciprotein particle levels can be reduced by dialysis, sodium thiosulphate and plasma exchange. Potential therapeutic implications for calciphylaxis?".
376:
The treatment of calciphylaxis requires a multidisciplinary approach, using the knowledge of nephrologists, plastic surgeons, dermatologists, and wound care specialists working together to manage the disease and its outcomes.
394:
therapy may also be considered. There are some smaller retrospective studies that show the use of hyperbaric oxygen in improving delivery of oxygen to wounds, which improves blood flow and helps with wound healing.
1748:
1419:
Bajaj, Richa; Courbebaisse, Marie; Kroshinsky, Daniela; Thadhani, Ravi I.; Nigwekar, Sagar U. (September 2018). "Calciphylaxis in
Patients With Normal Renal Function: A Case Series and Systematic Review".
997:
Lal, Geeta; Nowell, Andrew G.; Liao, Junlin; Sugg, Sonia L.; Weigel, Ronald J.; Howe, James R. (December 2009). "Determinants of survival in patients with calciphylaxis: A multivariate analysis".
273:
small vessel mural calcification with or without endovascular fibrosis, extravascular calcification and vascular thrombosis, leading to tissue ischemia (including skin ischemia and, hence, skin
1512:
Brandenburg, Vincent M.; Kramann, Rafael; Rothe, Hansjörg; Kaesler, Nadine; Korbiel, Joanna; Specht, Paula; Schmitz, Sophia; Krüger, Thilo; Floege, Jürgen; Ketteler, Markus (29 January 2016).
259:
tissue has infarcted, wound healing seldom occurs, and ulcers are more likely to become secondarily infected. Many cases of calciphylaxis lead to systemic bacterial infection and death.
1312:
Shea, M Kyla; O’Donnell, Christopher J; Hoffmann, Udo; Dallal, Gerard E; Dawson-Hughes, Bess; Ordovas, José M; Price, Paul A; Williamson, Matthew K; Booth, Sarah L (1 June 2009).
1919:
466:, but they have also been used to treat calciphylaxis even though the exact mechanism in calciphylaxis is unknown. They are most beneficial in patients who have a genetic
446:
is commonly prescribed for treatment in patients with calciphylaxis. The actual mechanism of the drug is unknown, but several explanations have been proposed, including
1263:
Udomkarnjananun, Suwasin; Kongnatthasate, Kitravee; Praditpornsilpa, Kearkiat; Eiam-Ong, Somchai; Jaber, Bertrand L.; Susantitaphong, Paweena (February 2019).
1600:
Pittelkow, Mark R.; Wetter, David A.; Williams, Amy W. (October 2016). "Survival, Risk
Factors, and Effect of Treatment in 101 Patients With Calciphylaxis".
294:. Widespread intravascular calcification typical of calciphylaxis lesions occur in the myocardium and prevent normal diastolic filling of the ventricles.
1859:
427:
is also recommended for those who have difficulty managing phosphate and calcium level balance. However, risks include development of post-operative
1405:
500:
Avoiding further local tissue trauma (including avoiding all subcutaneous injections, and all not-absolutely-necessary infusions and transfusions)
423:
patients should also transition to hemodialysis, as only hemodialysis carries the added benefit of better phosphate and calcium control. Surgical
1169:"Hyperbaric oxygen therapy in the treatment of skin ulcers due to calcific uraemic arteriolopathy: experience from an Australian hyperbaric unit"
1032:
Baby, Deepak; Upadhyay, Meenakshi; Joseph, MDerick; Asopa, SwatiJoshi; Choudhury, BasantaKumar; Rajguru, JagadishPrasad; Gupta, Shivangi (2019).
2140:
1214:
Nigwekar, Sagar U.; Zhao, Sophia; Wenger, Julia; Hymes, Jeffrey L.; Maddux, Franklin W.; Thadhani, Ravi I.; Chan, Kevin E. (November 2016).
687:
Yu, Wesley Yung-Hsu; Bhutani, Tina; Kornik, Rachel; Pincus, Laura B.; Mauro, Theodora; Rosenblum, Michael D.; Fox, Lindy P. (1 March 2017).
320:
deficiency contributes to the development of calciphylaxis. Vitamin K acts as an inhibitor of calcification in vessel walls by activating
450:
of calcium, vasodilation, antioxidant properties, and restoration of endothelial function. Adverse effects of sodium thiosulfate include
1668:
Weenig RH, Sewell LD, Davis MD, McCarthy JT, Pittelkow MR (2007). "Calciphylaxis: natural history, risk factor analysis, and outcome".
215:
patients. It results in chronic non-healing wounds and indicates poor prognosis, with typical life expectancy of less than one year.
2051:
1124:
Rashid RM, Hauck M, Lasley M (Nov 2008). "Anti-nuclear antibody: a potential predictor of calciphylaxis in non-dialysis patients".
1852:
218:
Calciphylaxis is one type of extraskeletal calcification. Similar extraskeletal calcifications are observed in some people with
794:
1954:
2070:
270:. Unlike other forms of vascular calcifications (e.g., intimal, medial, valvular), calciphylaxis is characterized also by
2150:
1845:
497:
Correction of the underlying plasma calcium and phosphorus abnormalities (lowering the Ca x P product below 55 mg2/dL2)
355:. Patients who require or have undergone any type of vascular procedures are also at increased risk for poor outcomes.
451:
851:
Wilmer, William; Magro, Cynthia (2002). "Calciphylaxis: Emerging
Concepts in Prevention, Diagnosis, and Treatment".
1168:
652:
Angelis, M; Wong, LM; Wong, LL; Myers, S (1997). "Calciphylaxis in patients on hemodialysis: A prevalence study".
2046:
1914:
1902:
2117:
2065:
541:
called non-uremic calciphylaxis by
Nigwekar et al. Non-uremic calciphylaxis has been observed in patients with
1197:
207:
but can occur in the earlier stages of chronic kidney disease and rarely in people with normally functioning
1825:
566:
486:
542:
1948:
1944:
1876:
1763:
308:
204:
76:
1697:
Li JZ, Huen W (2007). "Images in clinical medicine. Calciphylaxis with arterial calcification".
2107:
431:(HBS), a disease state that causes low calcium and requires use of calcium supplementation and
1085:"Sodium thiosulfate treatment for calcific uremic arteriolopathy in children and young adults"
736:
Zhou Qian; Neubauer Jakob; Kern
Johannes S; Grotz Wolfgang; Walz Gerd; Huber Tobias B (2014).
2112:
1868:
1399:
1314:"Vitamin K supplementation and progression of coronary artery calcium in older men and women"
1191:
250:
The first skin changes in calciphylaxis lesions are mottling of the skin and induration in a
47:
Calciphylaxis on the abdomen of a patient with end stage kidney disease. Markings are in cm.
2010:
1987:
1909:
562:
515:
428:
344:
340:
223:
8:
2145:
1752:
1639:
Weenig RH (2008). "Pathogenesis of calciphylaxis: Hans Selye to nuclear factor kappa-B".
1084:
420:
416:
231:
1514:"Calcific uraemic arteriolopathy (calciphylaxis): data from a large nationwide registry"
339:, vitamin D derivatives (e.g. calcitriol, calcium-based binders, or systemic steroids),
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deficiency and have been shown to slow development of calciphylaxis lesions in a small
443:
435:, which should be avoided in patients with end-stage kidney disease and calciphylaxis.
321:
251:
235:
130:
62:
954:
Arseculeratne, G; Evans, AT; Morley, SM (2006). "Calciphylaxis – a topical overview".
754:
737:
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2018:
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118:
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96:
52:
1582:
1553:
Hayashi, Matsuhiko (August 2013). "Calciphylaxis: diagnosis and clinical features".
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1216:"A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors"
1995:
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1433:
570:
511:
459:
348:
212:
167:) or “Grey Scale”, is a rare syndrome characterized by painful skin lesions. The
92:
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homeostasis result in the deposition of calcium in the vessels, also known as
211:. Calciphylaxis is a rare but serious disease, believed to affect 1-4% of all
2134:
2090:
1977:
1940:
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463:
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267:
176:
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1710:
1265:"Treatment of Calciphylaxis in CKD: A Systematic Review and Meta-analysis"
673:
630:
573:, and a higher risk of death than those who have peripheral-only lesions.
2060:
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1530:
1513:
1480:
1101:
227:
86:
1740:
617:
Nigwekar, SU; Thadhani, R; Brandenburg, VM (May 2018). "Calciphylaxis".
1926:
475:
432:
419:, all of which are also risk factors for development of calciphylaxis.
365:
328:, a vitamin K antagonist, that limits vitamin K recycling in the body.
254:
pattern. As tissue thrombosis and infarction occurs, a black, leathery
188:
125:
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481:
Other acceptable treatments may include one or more of the following:
2033:
1809:
1785:
828:
811:
550:
447:
317:
312:
266:
systemic medial calcification of the arteries, i.e. calcification of
262:
Calciphylaxis is characterized by the following histologic findings:
137:
16:
Painful, necrotic skin lesions associated with chronic kidney disease
1820:
1418:
336:
325:
274:
239:
200:
192:
68:
1790:
1082:
332:
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91:
Female sex, obesity, use of
Warfarin, protein C or S deficiency,
39:
2082:
785:
Wolff, Klaus; Johnson, Richard; Saavedra, Arturo (2013-03-06).
529:
387:
255:
208:
184:
1598:
1511:
956:
Journal of the
European Academy of Dermatology and Venereology
787:
Fitzpatrick's Color Atlas and
Synopsis of Clinical Dermatology
302:
The cause of calciphylaxis is unknown. Calciphylaxis is not a
99:, use of vitamin D derivatives (calcitriol, systemic steroids)
467:
1083:
Araya CE, Fennell RS, Neiberger RE, Dharnidharka VR (2006).
1311:
616:
503:
Patients who have received kidney transplants also receive
1465:"Calciphylaxis from nonuremic causes: a systematic review"
335:, elevated calcium-phosphate product, medications such as
1667:
1179:(3): 139–44. Archived from the original on April 15, 2013
532:, severe infection originating from a non-healing ulcer.
953:
1213:
1031:
907:"Calciphylaxis: Diagnosis, Pathogenesis, and Treatment"
1462:
1166:
686:
1730:
784:
651:
171:
of calciphylaxis is unclear but believed to involve
1463:Nigwekar SU, Wolf M, Sterns RH, Hix JK (Jul 2008).
612:
610:
608:
606:
1209:
1207:
604:
602:
600:
598:
596:
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592:
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588:
586:
286:Severe forms of calciphylaxis may cause diastolic
117:Dialysis, analgesics, surgical wound debridement,
1123:
996:
518:and perhaps a mechanistic mediator (calciprotein)
380:
2132:
810:Tom, Cindy W.; Talreja, Deepak R. (March 2006).
403:Most patients with calciphylaxis are already on
1594:
1592:
1204:
583:
1853:
1220:Journal of the American Society of Nephrology
1167:Edsell ME, Bailey M, Joe K, Millar I (2008).
778:
689:"Warfarin-Associated Nonuremic Calciphylaxis"
238:. In rare cases, certain medications such as
1589:
1404:: CS1 maint: multiple names: authors list (
1038:Journal of Family Medicine and Primary Care
1034:"Calciphylaxis and its diagnosis: A review"
900:
898:
896:
894:
892:
890:
850:
1867:
1860:
1846:
1318:The American Journal of Clinical Nutrition
809:
789:(7th ed.). McGraw Hill. p. 429.
462:are a popular choice for the treatment of
331:Reported risk factors include female sex,
38:
1638:
1529:
1488:
1337:
1288:
1239:
1100:
1059:
1049:
922:
827:
753:
712:
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150:1-4% of all dialysis patients in the U.S.
1160:
887:
1552:
109:Clinical, skin biopsy may aid diagnosis
2133:
1696:
2141:Vascular-related cutaneous conditions
1841:
904:
245:
1955:Familial hypocalciuric hypercalcemia
1555:Clinical and Experimental Nephrology
290:from cardiac calcification, called
33:Calcific Uremic Arteriolopathy (CUA)
2071:Hypokalemic sensory overstimulation
1518:Nephrology Dialysis Transplantation
549:(treated with chemotherapy), liver
316:hypothesis has been proposed, that
220:high levels of calcium in the blood
203:. It is seen mostly in people with
13:
1632:
924:10.1097/01.ASW.0000554443.14002.13
438:
242:can also result in calciphylaxis.
14:
2162:
1726:
911:Advances in Skin & Wound Care
452:high anion gap metabolic acidosis
281:
1138:10.1111/j.1468-3083.2008.02606.x
968:10.1111/j.1468-3083.2006.01506.x
865:10.1046/j.1525-139X.2002.00052.x
553:(due to hazardous alcohol use),
2047:Hyperkalemic periodic paralysis
1915:Disorders of calcium metabolism
1546:
1505:
1456:
1412:
1354:
1305:
1256:
1117:
1076:
1025:
990:
619:New England Journal of Medicine
535:
514:effective and proposed a serum
142:1-year mortality rate is 45–80%
2118:Cerebral salt-wasting syndrome
2066:Hypokalemic periodic paralysis
1173:Diving and Hyperbaric Medicine
947:
844:
803:
729:
705:10.1001/jamadermatol.2016.4821
680:
645:
381:Analgesia and wound management
161:calcific uremic arteriolopathy
1:
755:10.1016/S0140-6736(14)60235-X
666:10.1016/S0039-6060(97)90212-9
576:
1614:10.1016/j.mayocp.2016.06.025
1434:10.1016/j.mayocp.2018.06.001
1269:Kidney International Reports
1126:J Eur Acad Dermatol Venereol
567:systemic lupus erythematosus
522:
487:tissue plasminogen activator
371:
358:
7:
1920:Hypercalcemia of malignancy
905:Chang, John J. (May 2019).
543:primary hyperparathyroidism
10:
2167:
1682:10.1016/j.jaad.2006.08.065
1653:10.1016/j.jaad.2007.12.006
1281:10.1016/j.ekir.2018.10.002
1051:10.4103/jfmpc.jfmpc_588_19
1011:10.1016/j.surg.2009.09.022
528:calciphylaxis patients is
2151:Ailments of unknown cause
2081:
2032:
2009:
1986:
1963:
1875:
1800:
1734:
1567:10.1007/s10157-013-0782-z
1196:: CS1 maint: unfit URL (
510:A group in 2013 reported
493:Maggot larval debridement
185:deeper layers of the skin
146:
136:
124:
113:
103:
85:
75:
61:
51:
46:
37:
29:
24:
1949:Dystrophic calcification
1945:Metastatic calcification
485:Clot-dissolving agents (
454:and high sodium levels (
349:low blood albumin levels
309:metastatic calcification
297:
222:, including people with
205:end-stage kidney disease
1602:Mayo Clinic Proceedings
1422:Mayo Clinic Proceedings
1330:10.3945/ajcn.2008.27338
816:Mayo Clinic Proceedings
1869:Electrolyte imbalances
1232:10.1681/ASN.2015091065
399:Risk factor mitigation
1711:10.1056/NEJMicm060859
1670:J. Am. Acad. Dermatol
1641:J. Am. Acad. Dermatol
1469:Clin J Am Soc Nephrol
1089:Clin J Am Soc Nephrol
631:10.1056/NEJMra1505292
1910:Milk-alkali syndrome
1481:10.2215/cjn.00530108
1364:Nephrology (Carlton)
1102:10.2215/CJN.01520506
853:Seminars in Dialysis
563:rheumatoid arthritis
429:hungry bone syndrome
224:milk-alkali syndrome
1894:Symptoms and signs
421:Peritoneal dialysis
417:hyperparathyroidism
232:hyperparathyroidism
179:located within the
1801:External resources
1531:10.1093/ndt/gfv438
555:cholangiocarcinoma
444:Sodium thiosulfate
322:matrix Gla protein
252:livedo reticularis
246:Signs and symptoms
236:hypervitaminosis D
201:lack of blood flow
131:Sodium thiosulfate
2128:
2127:
1835:
1834:
1608:(10): 1384–1394.
1376:10.1111/nep.12137
1226:(11): 3421–3429.
796:978-0-07-179302-5
625:(18): 1704–1714.
505:immunosuppression
472:prospective study
425:parathyroidectomy
409:hyperphosphatemia
392:Hyperbaric oxygen
353:diabetes mellitus
154:
153:
119:parathyroidectomy
105:Diagnostic method
97:diabetes mellitus
81:Infection, sepsis
19:Medical condition
2158:
1935:Calcinosis cutis
1862:
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1509:
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1428:(9): 1202–1212.
1416:
1410:
1409:
1403:
1395:
1358:
1352:
1351:
1341:
1324:(6): 1799–1807.
1309:
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1080:
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1063:
1053:
1044:(9): 2763–2767.
1029:
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1005:(6): 1028–1034.
994:
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987:
951:
945:
944:
926:
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885:
884:
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842:
841:
831:
829:10.4065/81.3.335
812:"Heart of Stone"
807:
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782:
776:
775:
757:
733:
727:
726:
716:
693:JAMA Dermatology
684:
678:
677:
660:(6): 1083–1090.
649:
643:
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614:
304:hypersensitivity
159:, also known as
42:
22:
21:
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2077:
2028:
2005:
1982:
1959:
1871:
1866:
1836:
1831:
1830:
1796:
1795:
1743:
1729:
1699:N. Engl. J. Med
1635:
1633:Further reading
1630:
1629:
1597:
1590:
1551:
1547:
1510:
1506:
1461:
1457:
1417:
1413:
1397:
1396:
1359:
1355:
1310:
1306:
1261:
1257:
1212:
1205:
1189:
1188:
1182:
1180:
1165:
1161:
1122:
1118:
1081:
1077:
1030:
1026:
995:
991:
952:
948:
903:
888:
849:
845:
808:
804:
797:
783:
779:
738:"Calciphylaxis"
734:
730:
685:
681:
650:
646:
615:
584:
579:
571:body mass index
559:Crohn's disease
538:
525:
512:plasma exchange
460:Bisphosphonates
441:
439:Pharmacotherapy
401:
383:
374:
361:
300:
284:
248:
191:, and eventual
93:hypoalbuminemia
20:
17:
12:
11:
5:
2164:
2154:
2153:
2148:
2143:
2126:
2125:
2123:
2122:
2121:
2120:
2115:
2110:
2100:
2099:
2098:
2096:Salt poisoning
2087:
2085:
2079:
2078:
2076:
2075:
2074:
2073:
2068:
2058:
2057:
2056:
2055:
2054:
2038:
2036:
2030:
2029:
2027:
2026:
2021:
2015:
2013:
2007:
2006:
2004:
2003:
1998:
1992:
1990:
1984:
1983:
1981:
1980:
1975:
1969:
1967:
1961:
1960:
1958:
1957:
1952:
1938:
1924:
1923:
1922:
1912:
1907:
1906:
1905:
1903:Trousseau sign
1900:
1892:
1887:
1881:
1879:
1873:
1872:
1865:
1864:
1857:
1850:
1842:
1833:
1832:
1829:
1828:
1817:
1805:
1804:
1802:
1798:
1797:
1794:
1793:
1782:
1771:
1760:
1744:
1739:
1738:
1736:
1735:Classification
1728:
1727:External links
1725:
1724:
1723:
1694:
1665:
1634:
1631:
1628:
1627:
1588:
1561:(4): 498–503.
1545:
1524:(1): 126–132.
1504:
1475:(4): 1139–43.
1455:
1411:
1353:
1304:
1275:(2): 231–244.
1255:
1203:
1159:
1132:(10): 1247–8.
1116:
1075:
1024:
989:
962:(5): 493–502.
946:
917:(5): 205–215.
886:
859:(3): 172–186.
843:
802:
795:
777:
748:(9922): 1067.
728:
699:(3): 309–314.
679:
644:
581:
580:
578:
575:
537:
534:
524:
521:
520:
519:
508:
501:
498:
495:
490:
440:
437:
400:
397:
382:
379:
373:
370:
360:
357:
299:
296:
292:heart of stone
283:
282:Heart of stone
280:
279:
278:
271:
247:
244:
152:
151:
148:
144:
143:
140:
134:
133:
128:
122:
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55:
49:
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44:
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35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2163:
2152:
2149:
2147:
2144:
2142:
2139:
2138:
2136:
2119:
2116:
2114:
2111:
2109:
2106:
2105:
2104:
2101:
2097:
2094:
2093:
2092:
2089:
2088:
2086:
2084:
2080:
2072:
2069:
2067:
2064:
2063:
2062:
2059:
2053:
2050:
2049:
2048:
2045:
2044:
2043:
2040:
2039:
2037:
2035:
2031:
2025:
2022:
2020:
2017:
2016:
2014:
2012:
2008:
2002:
1999:
1997:
1994:
1993:
1991:
1989:
1985:
1979:
1976:
1974:
1971:
1970:
1968:
1966:
1962:
1956:
1953:
1950:
1946:
1942:
1941:Calcification
1939:
1936:
1932:
1931:Calciphylaxis
1928:
1925:
1921:
1918:
1917:
1916:
1913:
1911:
1908:
1904:
1901:
1899:
1898:Chvostek sign
1896:
1895:
1893:
1891:
1888:
1886:
1883:
1882:
1880:
1878:
1874:
1870:
1863:
1858:
1856:
1851:
1849:
1844:
1843:
1840:
1827:
1823:
1822:
1818:
1816:
1812:
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1807:
1806:
1803:
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1766:
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1755:
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1746:
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1742:
1737:
1733:
1720:
1716:
1712:
1708:
1704:
1700:
1695:
1691:
1687:
1683:
1679:
1676:(4): 569–79.
1675:
1671:
1666:
1662:
1658:
1654:
1650:
1647:(3): 458–71.
1646:
1642:
1637:
1636:
1623:
1619:
1615:
1611:
1607:
1603:
1595:
1593:
1584:
1580:
1576:
1572:
1568:
1564:
1560:
1556:
1549:
1541:
1537:
1532:
1527:
1523:
1519:
1515:
1508:
1500:
1496:
1491:
1486:
1482:
1478:
1474:
1470:
1466:
1459:
1451:
1447:
1443:
1439:
1435:
1431:
1427:
1423:
1415:
1407:
1401:
1393:
1389:
1385:
1381:
1377:
1373:
1370:(11): 724–7.
1369:
1365:
1357:
1349:
1345:
1340:
1335:
1331:
1327:
1323:
1319:
1315:
1308:
1300:
1296:
1291:
1286:
1282:
1278:
1274:
1270:
1266:
1259:
1251:
1247:
1242:
1237:
1233:
1229:
1225:
1221:
1217:
1210:
1208:
1199:
1193:
1178:
1174:
1170:
1163:
1155:
1151:
1147:
1143:
1139:
1135:
1131:
1127:
1120:
1112:
1108:
1103:
1098:
1095:(6): 1161–6.
1094:
1090:
1086:
1079:
1071:
1067:
1062:
1057:
1052:
1047:
1043:
1039:
1035:
1028:
1020:
1016:
1012:
1008:
1004:
1000:
993:
985:
981:
977:
973:
969:
965:
961:
957:
950:
942:
938:
934:
930:
925:
920:
916:
912:
908:
901:
899:
897:
895:
893:
891:
882:
878:
874:
870:
866:
862:
858:
854:
847:
839:
835:
830:
825:
821:
817:
813:
806:
798:
792:
788:
781:
773:
769:
765:
761:
756:
751:
747:
743:
739:
732:
724:
720:
715:
710:
706:
702:
698:
694:
690:
683:
675:
671:
667:
663:
659:
655:
648:
640:
636:
632:
628:
624:
620:
613:
611:
609:
607:
605:
603:
601:
599:
597:
595:
593:
591:
589:
587:
582:
574:
572:
568:
564:
560:
556:
552:
548:
547:breast cancer
544:
533:
531:
517:
513:
509:
506:
502:
499:
496:
494:
491:
488:
484:
483:
482:
479:
477:
473:
469:
465:
461:
457:
456:hypernatremia
453:
449:
445:
436:
434:
430:
426:
422:
418:
414:
413:hypercalcemia
410:
406:
396:
393:
389:
378:
369:
367:
356:
354:
350:
346:
342:
338:
334:
329:
327:
323:
319:
314:
310:
305:
295:
293:
289:
288:heart failure
276:
272:
269:
265:
264:
263:
260:
257:
253:
243:
241:
237:
233:
229:
225:
221:
216:
214:
210:
206:
202:
198:
194:
190:
186:
182:
178:
177:blood vessels
175:of the small
174:
173:calcification
170:
166:
162:
158:
157:Calciphylaxis
149:
145:
141:
139:
135:
132:
129:
127:
123:
120:
116:
112:
108:
106:
102:
98:
94:
90:
88:
84:
80:
78:
77:Complications
74:
70:
66:
64:
60:
56:
54:
50:
45:
41:
36:
32:
28:
25:Calciphylaxis
23:
1930:
1819:
1808:
1784:
1773:
1762:
1747:
1705:(13): 1326.
1702:
1698:
1673:
1669:
1644:
1640:
1605:
1601:
1558:
1554:
1548:
1521:
1517:
1507:
1472:
1468:
1458:
1425:
1421:
1414:
1400:cite journal
1367:
1363:
1356:
1321:
1317:
1307:
1272:
1268:
1258:
1223:
1219:
1192:cite journal
1181:. Retrieved
1176:
1172:
1162:
1129:
1125:
1119:
1092:
1088:
1078:
1041:
1037:
1027:
1002:
998:
992:
959:
955:
949:
914:
910:
856:
852:
846:
819:
815:
805:
786:
780:
745:
741:
731:
696:
692:
682:
657:
653:
647:
622:
618:
539:
536:Epidemiology
526:
480:
464:osteoporosis
442:
405:hemodialysis
402:
384:
375:
362:
345:S deficiency
330:
301:
291:
285:
268:tunica media
261:
249:
217:
181:fatty tissue
169:pathogenesis
164:
160:
156:
155:
87:Risk factors
71:skin lesions
228:sarcoidosis
189:blood clots
30:Other names
2146:Nephrology
2135:Categories
1927:Calcinosis
1775:DiseasesDB
1183:2013-04-02
822:(3): 335.
742:The Lancet
577:References
565:(RA), and
476:Cinacalcet
433:calcitriol
366:vasculitis
313:Adipocytes
230:, primary
126:Medication
57:Nephrology
2108:Hypotonic
2034:Potassium
2011:Phosphate
1988:Magnesium
1810:eMedicine
1791:237900002
1786:SNOMED CT
941:128352461
772:208788507
551:cirrhosis
523:Prognosis
448:chelation
372:Treatment
359:Diagnosis
341:protein C
318:vitamin K
147:Frequency
138:Prognosis
114:Treatment
53:Specialty
2113:Isotonic
1965:Chloride
1821:Orphanet
1815:derm/555
1719:17898102
1690:17141359
1661:18206262
1622:27712637
1583:28517319
1575:23430392
1540:26908770
1499:18417747
1450:51883048
1442:30060958
1384:24571743
1348:19386744
1299:30775620
1250:27080977
1154:37539737
1146:18422539
1111:17699342
1070:31681640
1019:19958929
984:20586832
976:16684274
933:31008757
881:45511014
873:12100455
838:16529137
764:24582472
723:28099971
639:29719190
337:warfarin
326:warfarin
275:necrosis
240:warfarin
213:dialysis
195:of skin
69:necrotic
67:Painful
63:Symptoms
1877:Calcium
1769:D002115
1490:2440281
1392:5252893
1339:2682995
1290:6365410
1241:5084892
1061:6820424
999:Surgery
714:5703198
674:9426423
654:Surgery
333:obesity
209:kidneys
199:due to
2083:Sodium
2052:equine
1826:280062
1758:275.49
1717:
1688:
1659:
1620:
1581:
1573:
1538:
1497:
1487:
1448:
1440:
1390:
1382:
1346:
1336:
1297:
1287:
1248:
1238:
1152:
1144:
1109:
1068:
1058:
1017:
982:
974:
939:
931:
879:
871:
836:
793:
770:
762:
721:
711:
672:
637:
530:sepsis
516:marker
415:, and
388:sepsis
351:, and
256:eschar
234:, and
1579:S2CID
1446:S2CID
1388:S2CID
1150:S2CID
980:S2CID
937:S2CID
877:S2CID
768:S2CID
468:ENPP1
298:Cause
197:cells
193:death
2091:High
2042:High
2019:High
1996:High
1973:High
1885:High
1780:1897
1764:MeSH
1753:9-CM
1715:PMID
1686:PMID
1657:PMID
1618:PMID
1571:PMID
1536:PMID
1495:PMID
1438:PMID
1406:link
1380:PMID
1344:PMID
1295:PMID
1246:PMID
1198:link
1142:PMID
1107:PMID
1066:PMID
1015:PMID
972:PMID
929:PMID
869:PMID
834:PMID
791:ISBN
760:PMID
719:PMID
670:PMID
635:PMID
183:and
2103:Low
2061:Low
2024:Low
2001:Low
1978:Low
1890:Low
1749:ICD
1707:doi
1703:357
1678:doi
1649:doi
1610:doi
1563:doi
1526:doi
1485:PMC
1477:doi
1430:doi
1372:doi
1334:PMC
1326:doi
1285:PMC
1277:doi
1236:PMC
1228:doi
1134:doi
1097:doi
1056:PMC
1046:doi
1007:doi
1003:146
964:doi
919:doi
861:doi
824:doi
750:doi
746:383
709:PMC
701:doi
697:153
662:doi
658:122
627:doi
623:378
458:).
343:or
165:CUA
2137::
1947:,
1933:,
1824::
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1616:.
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1001:.
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970:.
960:20
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889:^
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820:81
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814:.
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744:.
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707:.
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163:(
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
