| Abstract [eng] |
Background. Chronic kidney disease is a growing problem worldwide, affecting 13,4 % of the population and causing 5-10 million deaths yearly. Without treatment, it progresses to advanced stages with complications. Calciphylaxis, a life-threatening complication, affects 4 % of haemodialysis patients annually. It is often detected late, with a high one-year mortality rate. Objective. To describe and compare three cases of calciphylaxis in patients with chronic kidney disease and to review the literature on this theme, discussing its main aspects. Methods. Data from the medical records of three patients at Vilnius University Hospital Santaros Clinics and publications from international medical databases Medline (Pubmed), UpToDate and Google Scholar, published between 2015 and 2025. Results. The described cases occurred in end-stage chronic kidney disease patients on haemodialysis. The first case was notable for atypical symptoms – general weakness, hypotension, insomnia, followed by wounds, arm swelling and itching. The patient refused scintigraphy and had a skin biopsy, which did not confirm calciphylaxis, but suspicion remained. The second case highlighted key risk factors including warfarin and methylprednisolone use. This patient struggled with pain control and needed narcotic painkillers. Both patients died of septic shock. The third patient showed severe calciphylaxis signs: blisters, ulcers with scabs, arm swelling, sensory and movement issues. Diagnosis was based on clinical suspicion. He was treated with sodium thiosulphate. He died of heart failure before effectiveness could be assessed. Therefore, chronic kidney disease can lead to calciphylaxis, a rare life-threatening complication. It is influenced by high levels of parathyroid hormone, calcium, phosphate, activated vitamin D, low levels of calcification inhibitors. Calcification and thrombosis usually affect the medial layer of small arteries. Painful, slow-healing skin lesions and ulcers are common symptoms. There is no recommended diagnostic method. Diagnosis depends on clinical suspicion and available methods, with skin biopsy as the gold standard. While there is no specific treatment, managing renal disease and mineral metabolism is important. Sodium thiosulphate is the most effective drug. Research shows a rising incidence trend. Conclusions. Calciphylaxis is a serious complication with unknown mechanisms. Causes pain and impairs quality of life. Screening helps prevent it. The risk varies across renal replacement therapies (highest in haemodialysis patients). Early detection depends on knowing typical damage sites, common risk factors and increasing the availability of effective diagnostic methods. Clinical data registries help identify key aspects and improve management of this complication more effectively. The cases confirm calciphylaxis’s complexity and need for better management. |
