Background
- Syndrome of skin ischemia and necrosis in the context of end-stage renal disease on dialysis
- Rarely occurs in patients without ESRD, particularly with hyperparathyroidism, malignancy, alcoholic liver disease, and connective tissue diseases
Clinical Manifestations
- Presents with necrotic ulcerations basically anywhere
- Lesions may start as a purplish, painful, subcutaneous nodules or plaques, indurations, or livedo reticularis
Diagnosis
- Mostly clinical
- No specific laboratory abnormalities
- Biopsy may show dermo-hypodermal and pannicular arteriolar calcification, subintimal fibrosis, and thrombotic occlusion
Management
- Continue dialysis
- Wound care and pain management
- Treat infections as indicated
- Consider treating hyperphosphatemia (using sevelamer or lanthanum)
- Consider treating elevated PTH with cinacalcet
