Diagnosis

Diagnosis at Mayo Clinic

To determine if you have calciphylaxis, your doctor will review your medical history, assess your symptoms and do a physical exam. Tests may include:

  • Deep skin biopsy. To diagnose calciphylaxis, your doctor may remove a small tissue sample from an area of affected skin for analysis.
  • Blood tests. Mayo Clinic labs will analyze a blood sample to measure a variety of substances in your blood — calcium, phosphorus, parathyroid hormone, aluminum, urea nitrogen, creatinine and albumin, among others — to help your doctor assess your kidney and liver function.
  • Imaging studies. X-rays may show branch-like calcium deposits in the blood vessels (vascular calcifications) that are common in calciphylaxis. However, vascular calcifications are also common in other advanced kidney diseases.

Read more about the blood urea nitrogen (BUN test), creatinine test and liver function tests.

Treatment

Treatment at Mayo Clinic

No standard or universally effective treatment for calciphylaxis exists. Early diagnosis and treatment offer the best chance to reduce the effects. At Mayo Clinic, calciphylaxis is treated using three approaches explained below.

Applying intensive wound treatment

Your doctor will recommend aggressive wound care. For sores to heal, some of the tissue damaged by calciphylaxis may need to be surgically removed (debridement). In some cases, tissue can be removed using other methods, such as wet dressings or whirlpool treatments, among others. Antibiotic treatment is part of treating and preventing wound infection. You may be offered medication to assist with pain due to the calciphylaxis or wound care.

Restoring oxygen and blood flow to the skin

Your doctor may recommend hyperbaric oxygen therapy to increase oxygen delivery to the affected parts of the body. Also, your doctor may use low-dose tissue plasminogen activator (TPA) to dissolve blood clots in the tiny blood vessels of the skin. Medication that helps keep your blood from clotting (anticoagulation medication) may be prescribed to restore blood flow to the tissues. Your doctor will go over with you the best anticoagulant for your case.

Decreasing calcium deposits

Reducing calcium deposits in your arteries may be helped by:

  • Dialysis. Your doctor may change your dialysis prescription if you're on kidney dialysis, including the medications used in and the frequency of your dialysis.
  • Medications to reduce calcium. Your doctor will evaluate your current medications and eliminate potential triggers for calciphylaxis, such as corticosteroids or iron, and may modify the amount (dose) of your calcium or vitamin D supplements. Your doctor may also recommend a medication called cinacalcet (Sensipar), which can help control parathyroid hormone (PTH). Other medications may include sodium thiosulfate, which binds with calcium so it passes out of the body in urine, and medications to improve the balance of calcium and phosphorus.
  • Surgery. If your doctor determines that an overactive parathyroid gland (hyperparathyroidism) is contributing to the abnormal calcium metabolism by producing too much PTH, surgery to remove all or part of the parathyroid glands may be recommended.

Calciphylaxis care at Mayo Clinic

June 18, 2015
References
  1. Santos PW, et al. Calciphylaxis (calcific uremic arteriolopathy). http://www.uptodate.com/home. Accessed May 7, 2015.
  2. AskMayoExpert. How is calciphylaxis treated? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  3. AskMayoExpert. What tests are used to diagnose calciphylaxis? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  4. Nigwekar SU, et al. Calciphylaxis: Risk factors, diagnosis, and treatment. American Journal of Kidney Diseases. In press. Accessed May 13, 2015.
  5. Wangen T, et al. Calciphylaxis: An unusual case with an unusual outcome. The American Journal of Nursing. 2014;114:24.
  6. Brandenburg VM, et al. Calciphylaxis in CKD and beyond. Nephrology Dialysis Transplantation. 2012;27:1314.
  7. Vedvyas C, et al. Calciphylaxis: A systematic review of existing and emerging therapies. Journal of the American Academy of Dermatology. 2012;67:e253.
  8. El-Azhary RA, et al. Retrospective analysis of tissue plasminogen activator as an adjuvant treatment for calciphylaxis. JAMA Dermatology. 2013;149:63.
  9. El-Azhary RA (expert opinion). Mayo Clinic, Rochester, Minn. June 6, 2015.
  10. Sluzevich JC (expert opinion). Mayo Clinic, Jacksonville, Fla. May 26, 2015.