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A Syndrome of Tissue Necrosis and Vascular Calcification in 11 Patients With Chronic Renal Failure

Robert M. Gipstein, MD; Jack W. Coburn, MD; Donald A. Adams, MD; David B. N. Lee, MD; Khosrow P. Parsa, MD; Alvin Sellers, MD; Wadi N. Suki, MD; Shaul G. Massry, MD

Arch Intern Med. 1976;136(11):1273-1280.

Abstract
Eleven patients with chronic renal failure and presumed secondary hyperparathyroidism developed a syndrome of medial calcinosis of the arteries and painful ischemic ulcers of the fingers, legs, or thighs, or any combination of the three. Five patients required maintenance hemodialysis; six had functioning renal homografts. Severe hyperphosphatemia had existed in each; seven showed roentgenographic evidence of subperiosteal resorption. Similarities are evident between the lesions and experimentally produced calciphylaxis. The lesions demonstrated a relentless, progressive course, with serious morbidity and mortality. Hyperplastic or adenomatous parathyroid tissue was removed from ten of 11 patients undergoing surgical procedures; healing followed in seven patients.

Treatment with phosphate-binding antacids to lower serum phosphorus levels may prevent this syndrome. Total or subtotal parathyroidectomy should be considered when ischemic skin lesions appear in uremic patients or in renal transplant recipients.

(Arch Intern Med 136:1273-1280, 1976)

Author Affiliations
From the medical and research services, Veterans Administration Wadsworth Hospital Center, Los Angeles (Dr Coburn); and the departments of medicine, Cedars-Sinai Medical Center, Los Angeles (Drs Massry and Sellers), Santa Monica Hospital, Santa Monica, Calif (Drs Gipstein and Adams), Harbor General Hospital, Torrence, Calif (Dr Parsa), University of California at Los Angeles School of Medicine (Dr Lee), and Methodist Hospital, Baylor College of Medicine, Houston (Dr Suki).

Footnotes
Received for publication June 2, 1975; accepted Jan 6, 1976.

Presented in part at the 53rd annual meeting of the American College of Physicians, Atlantic City, NJ, April 20, 1972, and at the fifth annual meeting of the Internal Society of Nephrology, Mexico City, October 11, 1972.

Reprint requests to 11860 Wilshire Blvd, Los Angeles, CA 90025 (Dr Gipstein).

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