Back to dialysis after third Kidney transplant failure with severe calcific uremic arteriolopathy

Author(s): Sawsan Babiker

Introduction: Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a serious condition with high mortality rate, characterized by skin ischemia, necrosis, and thrombosis due to calcium  deposition. Frequent dialysis, sodium-thiosulphate (STH), vitamin K, and hyperbaric oxygen are  trials with variable results. Steroid & warfarin are the most risk factors contributing for  development of CUA. This middle age CKD female, post kidney transplantation failure, three  times, all were commercial, was on steroid, developed vascular access failure and calciflaxis  secondary to inadequate dialysis, with heart involvement, mitral annulus calcifications (MAC),  and life threatening arrhythmias. 

Results: Investigations showed high parathyroid hormone, normal serum phosphate and  calcium, anemia, hypoalbuminemia, pulmonary CTA showed severe stenosis of left  brachiocephalic and superior vena cava, echo revealed severe mitral annular calcification . 

Calciphylaxis Graft calcification 

Discussion: Permanent vascular access is important for dialysis adequacy. Calcific uremic  arteriolopathy (CUA) is a life threatening condition. That following graft failure, and associated  with inadequate dialysis, has poor response to current therapy polices and poor outcome, with  cardiac involvement, including valve calcifications ,specially mitral annulus calcifications (MAC)  that in this case inamenable to treatment or prevention due to vascular access failure and  inability to implant device or pacemaker