Join Us | Latest Articles | Contact

Journal Home

Editorial Board

Recent Articles

Submit to this journal

Special Issues

Current issue

Clinical Medical Image Library

Vascular Calcifications in Calcific Uremic Arteriolopathy

Filipa Brito Mendes1*, André Fragoso1, Ana Paula Silva1,2 and Pedro Neves1,2

1Nephrology Department, Algarve Hospital Centre, Portugal
2Department of Biomedical Science, Algarve University, Portugal

*Corresponding author: Filipa Brito Mendes, Nephrology Department, Algarve Hospital Centre, Portugal, E-mail:
Clin Med Img Lib, CMIL-2-050, (Volume 2, Issue 7); ISSN: 2474-3682
Published Date: August 13, 2016
Citation: Mendes FB, Fragoso A, Silva AP, Neves P (2016) Vascular Calcifications in Calcific Uremic Arteriolopathy. Clin Med Img Lib 2:050.
Copyright: © 2016 Mendes FB, et al. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Calcific Uremic Arteriolopathy (CUA) or Calciphylaxis, is a severe morbid and life-threatening condition 1. Ischemic subcutaneous necrosis with vulnerable skin ulcerations are some of the characteristics of this rare but global spread disease.

Despite the diagnosis of CUA is clinical, histological confirmation remains the gold standard for definitive diagnosis. Biopsies describe small arteries and arteriolar medial calcification, intimal hyperplasia, inflammation with endovascular fibrosis and microthrombi [1].

Although the process of vascular calcification was thought to be a passive deposition of calcium-phosphate crystals, the present knowledge suggests cellular activity with differentiation of vascular smooth muscle cells (VSMCs) into chondrocyte as well as osteoblast-like cellular phenotypes and deficiencies in calcification inhibitors [2].

Known as vascular calcification important inhibitors there are: Fetuin A/α2-Heremans Schmid glycoprotein (AHSG), produced by the liver but acting as a systemic inhibitor of hydoxyapatite synthesis; the Matrix Gla Protein (MGP) which binds to insoluble calcium salts preventing hydroxyapatite crystals growth and, by blocking osteo-inductive properties of bone morphogenic protein-2, inhibits VSMCs from differentiating into osteoblast-like phenotypes. Finally the Growth Arrest Specific gene 6 (Gas 6) which has a protective role against vascular injury [3].

MGP and Gas 6 are both vitamin-K dependents proteins, so vitamin K antagonists’ intake, such as warfarin, may compromise these calcification inhibitors activation. Vitamin K2, one of the two types of vitamin K, is the most important for the peripheral gamma-carboxylation of MGP and Gas-6 [4].

Supporting warfarin as a precipitating factor for CUA development we report a case of a 65-year-old male gender patient with End-stage Renal Disease under hemodialysis for 6 years and a one-year mechanic aortic valve, taking warfarin, presenting typical skin lesions (Figure 1) and marked vascular calcifications (Figure 2). CUA was admitted as a probable diagnosis. Besides the positive anamnesis, biopsy was performed for confirmation. Treatment was established with relatively good outcome.

At two and half years of follow-¬up, the patient is alive. Although, he presents with recurrent arterial stenoses (Figure 3) which can be interpreted due to the process above described.

International Journal of Anesthetics and Anesthesiology (ISSN: 2377-4630)
International Journal of Blood Research and Disorders   (ISSN: 2469-5696)
International Journal of Brain Disorders and Treatment (ISSN: 2469-5866)
International Journal of Cancer and Clinical Research (ISSN: 2378-3419)
International Journal of Clinical Cardiology (ISSN: 2469-5696)
Journal of Clinical Gastroenterology and Treatment (ISSN: 2469-584X)
Clinical Medical Reviews and Case Reports (ISSN: 2378-3656)
Journal of Dermatology Research and Therapy (ISSN: 2469-5750)
International Journal of Diabetes and Clinical Research (ISSN: 2377-3634)
Journal of Family Medicine and Disease Prevention (ISSN: 2469-5793)
Journal of Genetics and Genome Research (ISSN: 2378-3648)
Journal of Geriatric Medicine and Gerontology (ISSN: 2469-5858)
International Journal of Immunology and Immunotherapy (ISSN: 2378-3672)
International Journal of Medical Nano Research (ISSN: 2378-3664)
International Journal of Neurology and Neurotherapy (ISSN: 2378-3001)
International Archives of Nursing and Health Care (ISSN: 2469-5823)
International Journal of Ophthalmology and Clinical Research (ISSN: 2378-346X)
International Journal of Oral and Dental Health (ISSN: 2469-5734)
International Journal of Pathology and Clinical Research (ISSN: 2469-5807)
International Journal of Pediatric Research (ISSN: 2469-5769)
International Journal of Respiratory and Pulmonary Medicine (ISSN: 2378-3516)
Journal of Rheumatic Diseases and Treatment (ISSN: 2469-5726)
International Journal of Sports and Exercise Medicine (ISSN: 2469-5718)
International Journal of Stem Cell Research & Therapy (ISSN: 2469-570X)
International Journal of Surgery Research and Practice (ISSN: 2378-3397)
Trauma Cases and Reviews (ISSN: 2469-5777)
International Archives of Urology and Complications (ISSN: 2469-5742)
International Journal of Virology and AIDS (ISSN: 2469-567X)
More Journals

Contact Us

ClinMed International Library | Science Resource Online LLC
3511 Silverside Road, Suite 105, Wilmington, DE 19810, USA


Get Email alerts
Creative Commons License
Open Access
by ClinMed International Library is licensed under a Creative Commons Attribution 4.0 International License based on a work at
Copyright © 2017 ClinMed International Library. All Rights Reserved.