Table 1.
Patient numbers, patient characteristics | PD duration | Clinical presentation | CCa2+ (mmol/L) | PO4− (mmol/L) | PTH (ng/L) | Treatment | Outcome | Reference |
---|---|---|---|---|---|---|---|---|
n = 54 most female diabetics | > 2 months | 73% subcutaneous plaques 95% lower legs (95% bilateral) 5% abdomina l wall | n/a | n/a | n/a | Parathyroidectomy (n = 6) | 5 improve | |
[11] | ||||||||
Change to HD (n = 13) | 11 improve | |||||||
Steroid therapy (n = 19) | 3 die within 3 month8 improve 8 no change | |||||||
n = 169 female HTN, IHD, renal calculi, osteoarthritis, graves thyroid disease, osteoporosis | 3 months | Unilateral right calf violaceous lesion 1.5 inch, progressing to bilateral indurated lesions calf and thighs | 2.22 | 2.10 | 109 | D/C caltrate, calcitriol start sevelamer prednisolone STS (IV) | Resistant to all but STS, with improved pain in 2 weeks, and reduced lesion size in 8 weeks | [12] |
n = 126 female 2 failed transplant not on calcium salts | 4 years | Violaceous lesions progressing in 6 weeks to ulcerations of left proximal arm and bilateral thigh | 2.4 | 1.77 | 89 | Prior parathyroidectomy, initially STS (IV) 2 months STS (IP) 4 months | STS(IV) response but D/C due to N&V. STS(IP) no response and died from sepsis | [13] |
n = 153 female Moroccan obese, IDDM, IHD, CVA | 3 years | Redness right breast progressed to ulcerate Further progressed to bilateral breast and fingertip ulceration. Further progression to thigh | 2.7 | 2.0 | 1376 | Parathyroidectomy mastectomy STS—although very late | Poor response to all. Poor wound healing. Died from sepsis | [14] |
n = 117 male Afro-American Wegener's granulomatosis (receiving cyclophosphamide and prednisolone) previous warfarin (right atrial thrombus) | 3 years | Erythema and swelling bilateral metatarsals, progressed to necrotic feet and fingers, with scintigraphy evidence of widespread disease | 2.42 | 2.68 | 321 | D/C caltrate Sevelamer preexisting Aluminium commenced STS (IV) 3 months HBO Change to HD | Pain relief with STS but lesions progress. HBO did not halt Proceed to bilateral BKA. Change to HD 5x/week and disease healed | [15] |
PD: peritoneal dialysis, CCa2+: corrected calcium, PO4−: phosphate, PTH: parathyroid hormone, n: number, HD: hemodialysis, HTN: hypertension, IHD: ischemic heart disease, D/C: discontinue, STS: sodium thiosulphate, IV: intravenous, IP: intraperitoneal, N&V:, nausea and vomiting, IDDM: insulin-dependent diabetes mellitus, CVA: cerebrovascular accident, HBO: hyperbaric oxygen therapy, and BKA: below knee amputation.