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Study Compares Radiologic Imaging to Histopathology for Diagnosis of Calciphylaxis, an Oft-Fatal Condition Seen in Stage 5 Kidney Disease

Dermatologist and BioQuick News Science & Medicine Advisory Board Member (http://www.bioquicknews.com/node/34) Charles Halasz (photo), M.D., has had an article published online on March 9, 2017 in the Journal of the American Academy of Dermatology. The article is titled “Calciphylaxis: Comparison of Radiologic Imaging and Histopathology.” Dr. Halasz, Associate Professor of Dermatology at Columbia University, New York, and colleagues, sought to investigate whether radiologic imaging might offer any benefit over histopathology in the diagnosis of calciphylaxis. The current gold standard for diagnosis of calciphylaxis is a skin biopsy specimen demonstrating calcification of small-caliber arteries or arterioles. Calciphylaxis, or calcific uremic arteriolopathy (CUA), is a syndrome of calcification of small arteriolar blood vessels, with blood clots, and skin necrosis (https://en.wikipedia.org/wiki/Calciphylaxis). It is seen mostly in patients with stage 5 chronic kidney disease, but can occur in the absence of kidney failure. It results in chronic non-healing wounds and is often fatal. Here, the physicians sought to compare diameters of calcified vessels seen in skin biopsy specimens and radiology images of patients with calciphylaxis. They conducted a retrospective study of patients, with known calciphylaxis from 2009 to 2016 at a community hospital, who had both skin biopsy specimens and radiology images taken as part of their routine care. Vascular calcification was compared in skin biopsy specimens and radiology images. Seven patients were identified. Small-vessel calcification as fine as 0.1 to 0.3 mm was identified on plain films in 3 patients; 0.1 to 0.2 mm by mammography in 3 patients, and 0.1 to 0.2 mm by computed tomography imaging in 1 patient, nearly as fine a resolution as on histopathology. Based on the results of this small pilot study, the authors conclude that radiologic imaging might enable more rapid diagnosis of calciphylaxis when a skin biopsy specimen is pending or not available.

Dr. Halasz commented, “Calciphylaxis can be thought of as a calcification or arteriosclerosis of the microvasculature. Early detection and treatment, for example with intravenous sodium thiosulfate, can improve prognosis in this serious condition.”

In addition to first author Dr. Halasz, co-authors of this study include Dr. David Munger, Dr. Heather Frimmer, Dr. Michael Dicorato, and Dr. Sandra Wainwright. Reprint requests for the JAAD article may be addressed to Charles L. Halasz, M.D., Department of Medicine, Norwalk Hospital, 149 East Ave, Suite 20, Norwalk, CT 06851. In addition to his hospital affiliations, Dr. Halasz also has a private practice in Norwalk, Connecticut.

[Journal of the American Academy of Dermatology abstract] [BioQuick News Science & Medicine Advisors]