World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Case Report

Volume 6, Number 3-4, October 2017, pages 25-28

Calciphylaxis: Early Detection and Off-Label Treatment With Sodium Thiosulfate

Figures

Figure 1. Biopsy findings. The histological section demonstrates fibrin thrombi within small blood vessels and ischemic necrosis of the epidermis, consistent with calcific uremic arteriolopathy (CUA).

Figure 2. Necrotic ulcers before and after sodium thiosulfate.

Tables

**Table 1.** Patients’ Labs Pertinent to the Current Condition
Phosphorus	Albumin	Calcium	Corrected Ca	PTH	Ca × P
9.3 mg/dL ↑	3.0 mg/dL ↓	8.4 mg/dL	9.2 mg/dL	408.1 pg/mL ↑	85.56 ↑

**Table 2.** Risk Factors for CUA [4-12]
Risk factor	After reviewing many case reports, case series, and observational studies, the following were observed
Age	CUA is more reported in patients in the fifth decade of life.
Sex	CUA is seen more in women 2:1 men [4].
Race	CUA affected more whites compared to non-whites [4].
Calcium-phosphorus metabolism	CUA is related to impaired calcium-phosphorus metabolism in dialysis patients as calcium, phosphorus, vitamin D, PTH levels and treatment used as vitamin D [7, 8].
Comorbidities	CUA was observed with the presence of other medical diseases (DM-2, obesity, autoimmune conditions, hypercoagulable conditions, and liver disease) [4, 5, 9-11].
Medications	CUA was observed with the use of calcium supplements, calcium-based phosphate binders, active vitamin D, warfarin, corticosteroids, iron therapy, and trauma related to subcutaneous insulin or heparin injections have been associated with increased calciphylaxis risk [12].