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NDT Plus Advance Access published online on September 8, 2009
NDT Plus, doi:10.1093/ndtplus/sfp120
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The importance of prevention of calciphylaxis in patients who are at risk and the potential fallibility of calcimimetics in the treatment of calciphylaxis for patients with secondary hyperparathyroidism

Zain Khalpey, Matthew A. Nehs, Andrew W. ElBardissi, Marcus Semel and Stefan G. Tullius

Division of Transplantation Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

Correspondence: Stefan G. Tullius; E-mail: stullius{at}partners.org


  Abstract

A 43-year-old African American with end-stage renal disease (ESRD) associated with membranous nephropathy and a previously failed renal transplant had received cinacalcet to treat his secondary hyperparathyroidism. Serum calcium and phosphorus levels remained within normal limits, and serum parathyroid levels had dropped significantly following treatment initiation. However, within 7 months, the patient experienced extensive necrotic bilateral medial thigh ulcers. These were biopsied and found to be a result of calciphylaxis. The patient ultimately required an urgent subtotal parathyroidectomy and recovered well with completely healed ulcers.

Key Words: calciphylaxis • cinacalcet • hyperparathyroidism • sensipar

Received for publication July 6, 2009. Accepted for publication August 6, 2009.


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