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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Calcific uremic arteriolopathy (CUA) is a rare event primarily in patients with end-stage kidney disease which is characterized by small vessel media calcification, panniculitis, dermal necrosis producing exquisitely painful difficult to heal wounds. Mortality rates may be as high as 80%, predominantly due to intervening sepsis. This clinical phenomenon is being increasingly reported and treated with a widening number of agents. Recent case reports highlight the benefit of two modalities that have been employed as adjuvant therapy with significant success in the treatment of CUA. Hyperbaric oxygen (HBO) is capable of enhancing oxygen delivery to the ulcerating lesions that characterize CUA. Chronic hypoxia can be reversed using HBO to facilitate growth factor production, neoangiogenesis, fibroblast proliferation, and collagen synthesis that may facilitate all aspects of wound healing. Sodium thiosulfate appears to chelate and solubilize calcium ions, reducing the calcium vascular load that appears to participate in the obliterative small vessel disease. There is a rapid analgesic effect and slower regression of cutaneous calcific nodules. The authors advocate for aggressive treatment of CUA, using all available therapies.
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PMID:Calcific uremic arteriolopathy--the argument for hyperbaric oxygen and sodium thiosulfate. 2033 17

Calciphylaxis is a rare disease primarily affecting patients dependent on dialysis. It is characterised by small vessel media calcification leading to cutaneous ischemia and necrosis. The mortality rate is high with infection and sepsis being the most common causes of death. Calcium salts, vitamin D and high levels of serum calcium and phosphorus increase the risk of calciphylaxis. Current therapies including restoration of mineral homeostasis, wound care and pain control, are not entirely effective. Sodium thiosulfate, by dissolving calcium deposits, is a novel therapeutic choice for calciphylaxis. It has proved successful also in cases refractory to conventional treatment.
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PMID:[Sodium thiosulfate--new hope for the treatment of calciphylaxis]. 2197 87

Calciphylaxis occurs due to calcium deposition in arterioles, which leads to ischemic ulceration of overlying skin. Two-year mortality rates from sepsis ranges from 50% to 80%. Calciphylaxis is most common in hyperparathyroidism secondary to chronic renal impairment and rarely occurs in the setting of normal renal function. Biopsy of the calciphylaxis ulcer reveals calcium deposits lining the vascular intima. Tissue calcification may also be seen on plain radiographs. Calcium-phosphate metabolism should be normalized by treating any underlying hyperparathyroidism with bisphosphonates, parathyroidectomy, and/or cinacalcet in addition to dialysis in chronic renal failure. Intravenous sodium thiosulfate has been used successfully to treat renal and normo-renal calciphylaxis. Sodium thiosulfate displaces calcium ions from calcium deposits to form calcium thiosulfate, which is excreted by the kidneys or dialyzed. Systemic glucocorticoids may prevent ulceration of early plaques of calciphylaxis. Hyperbaric oxygen, skin grafting, and iloprost infusions are useful adjuncts in the management of this debilitating condition.
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PMID:Diagnosis and treatment of calciphylaxis. 2277 99

The authors review the presentation, diagnosis, and treatment of calciphylaxis and also describe applications of a novel therapeutic option, sodium thiosulfate. Two cases of advanced uremic calciphylaxis from both clinic and hospital settings are presented. One patient, a 57-year-old woman with end-stage renal disease, was treated with surgical debridement and sodium thiosulfate 25g three times a week. After introducing sodium thiosulfate treatment, the affected sites continue to heal with encouraging improvement of ulcer depth. Sodium thiosulfate was well-tolerated and facilitated wound healing. The patient did not develop sepsis. Sodium thiosulfate appears to be a viable first-line treatment for calciphylaxis and should be seriously considered early in the course of treatment.
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PMID:Sodium thiosulfate in the treatment of calciphylaxis. 2371 Feb 71

BACKGROUND Calcific uremic arteriolopathy (CUA) is a rare and incredibly painful cutaneous disorder secondary to microvascular involvement in which calcium dysregulation leads to stenosis of medium sized arterial blood vessels along with endothelial dysregulation and thrombosis. Ultimately, these patients are at high risk for non-healing wounds with risk of death from sepsis and multi-organ failure. It is a poorly understood condition with limited therapies that do not offer mortality benefit. Prevalence is about 4% in hemodialysis patients. Sodium thiosulfate (STS) can be used in hemodialysis patients but therapy is often limited by the development of high anion gap metabolic acidosis. CASE REPORT A 53-year-old male who had end stage renal disease and who was on hemodialysis and taking warfarin for bio-prosthetic mitral valve replacement and atrial fibrillation presented with non-healing right lower extremity cellulitis which had failed outpatient treatment. A skin biopsy of the lesion was consistent with CUA. The patient failed to improve on calcitriol and cinacalcet and was started on intravenous STS. Subsequently, he developed life threatening metabolic acidosis requiring a bicarbonate drip. He died 12 weeks after his initial diagnosis of CUA. CONCLUSIONS This article seeks to describe how the treatment of CUA; a rare disease with high mortality, is limited by the development of metabolic acidosis when using STS therapy. There is an 80% mortality rate within 6 months from CUA with major adverse effect of a high anion gap metabolic acidosis. Further research is needed in the field of establishing optimal dosing and frequency.
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PMID:Sodium-Thiosulfate Induced Life-Threatening Metabolic Acidosis Limiting Treatment of Calciphylaxis. 3233 46