UREMIC SMALL-ARTERY DISEASE WITH MEDIAL CALCIFICATION AND INTIMAL HYPERPLASIA (SO-CALLED CALCIPHYLAXIS) - A COMPLICATION OF CHRONIC-RENAL-FAILURE AND BENEFIT FROM PARATHYROIDECTOMY
UREMIC SMALL-ARTERY DISEASE WITH MEDIAL CALCIFICATION AND INTIMAL HYPERPLASIA (SO-CALLED CALCIPHYLAXIS) - A COMPLICATION OF CHRONIC-RENAL-FAILURE AND BENEFIT FROM PARATHYROIDECTOMY
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DOI：
10.1016/0190-9622(95)90286-4
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发表时间：
1995-12-01
影响因子：
13.8
通讯作者：
BURG, G
中科院分区：
文献类型：
--
作者：
HAFNER, J;KEUSCH, G;BURG, G
背景：尿毒症小动脉疾病伴内侧钙化和内膜增生可导致危及生命的皮肤坏死或肢端坏疽。它是慢性肾功能衰竭的一种独特并发症，必须与软组织钙化相鉴别。磷酸钙产物增加和继发性甲状旁腺功能亢进是主要的潜在病症。甲状旁腺切除术的益处存在争议。目的：本文基于文献检索来确定预后因素，特别是甲状旁腺切除术的益处。方法：回顾了有关尿毒症小动脉疾病（所谓的钙化防御）的文献（完整数据集：104 例，包括我们自己的 5 例）。分析了甲状旁腺切除术的治疗益处以及预后预测因素（定位、透析和肾移植）与结果之间的关系。还检查了糖尿病和肢端坏疽之间的关系。进一步建立了所审查患者组的流行病学数据。结果：58 名接受甲状旁腺切除术的患者中有 38 名存活，而 37 名未接受甲状旁腺切除术的患者中有 13 名存活（p=0.007，n=95）。 53 名远端坏死患者中有 40 名存活，而 42 名近端坏死患者中有 11 名存活（p
Background: Uremic small-artery disease with medial calcification and intimal hyperplasia can lead to life-threatening skin necrosis or acral gangrene. It is a distinct complication of chronic renal failure that must be differentiated from soft-tissue calcification. An increased calcium-phosphate product and secondary hyperparathyroidism are the main underlying conditions. The benefit of parathyroidectomy is controversial.Objective: This article is based on a literature search to determine prognostic factors and, in particular, the benefit of parathyroidectomy.Methods: The literature on uremic small-artery disease (so-called calciphylaxis) was reviewed (full data set: 104 cases, including five of our own). The therapeutic benefit of parathyroidectomy and the relation between prognostic predictors (localization, dialysis, and renal transplant) and outcome were analyzed. The relation between diabetes and acral gangrene was also examined. Further epidemiologic data on the reviewed group of patients were established.Results: Thirty-eight of 58 patients who underwent parathyroidectomy survived compared with 13 of 37 patients who did not undergo parathyroidectomy (p=0.007, n=95). Forty of 53 patients with distal localization of necrosis survived compared with 11 of 42 patients with proximal pattern (p