Un caso complesso di calcificassi associata ad iperparatiroidismo secondario (IPTII) con coesistenza di sindrome emolitico uremica SEU) in paziente già sottoposta a trapianto di rene

Research output: Other contribution

Abstract

[automatically translated] Introduction calcificassi is the extreme life-threatening complication of hyperparathyroidism IPT often type II. Its pathogenesis is uncertain because it involves individual variables related to a complex hypersensitivity reaction in the presence of PTH, Vitamin D and ipercalcemia.Una not always correlation between the severity of clinical signs and laboratory abnormalities and histologic makes the prognosis difficult. Sodium thiosulfate ev can reduce the precipitation of calcium and unclog the arteries improving the clinical picture representing over to parathyroidectomy (PTX) the only treatment capable of reducing the high risk of mortality Materials and methods: The clinical case we have given is a 60 aa woman with chronic kidney disease (CKD) on hemodialysis since 1999 resulting in Hemolytic Uremic Syndrome (HUS), transplanted from a donor cadaver kidney in April 2006. In the post-transplant recurrence of SEU makes necessariot reatment with plasmapheresis, blood transfusions and hemodialysis. Resolution of the HUS recurrence and graft functional recovery until December 2006 with graft loss and return to dialysis .Nell'aprile 2008 the patient arrives with a severe generalized clinical signs compatible with calcificassi from probable IPT II.La biopsy of skin lesions It describes football metastatic deposits and vascular changes that confirm the diagnosi.Lo study of Ca-P metabolism and parathyroid confirm the presence of IPT II; PTX is performed with the aid of intraoperative PTH and histology showed nodular hyperplasia of the parathyroid glands 5. Not improving the clinical picture starts treatment with sodium thiosulfate 25 g three times a week after dialysis. Results: Despite an improvement of skin lesions general conditions remained severe further witnessing the emergence of generalized septic complications that led to exitus of the patient Conclusions: The calcificassi still is burdened by high mortality rate. There are still unresolved issues regarding its pathogenesis, as not all patients with IPT II develop this syndrome and there is not always a correlation between clinical evidence and laboratory abnormalities of metabolism P. Ca- This variable could be linked to preexisting vascular changes that would make the favoring of Ca deposits, so it is desirable to discover which are the IPT II preexisting conditions that would be responsible for the color to change it in calcificassi. The possibility of achieving a selection of patients in risk classes for the development of calcificassi may direct a therapeutic to standardized protocol in order to prevent such a formidable syndrome putting in place a preventive parathyroidectomy avoiding the high mortality rate in patients in whom the likely to develop the calcificassi is extremely high. Therefore, it is desirable to discover which are the IPT II preexisting conditions that would be responsible for the color to change it in calcificassi. The possibility of achieving a selection of patients in risk classes for the development of calcificassi may direct a therapeutic to standardized protocol in order to prevent such a formidable syndrome putting in place a preventive parathyroidectomy avoiding the high mortality rate in patients in whom the likely to develop the calcificassi is extremely high. Therefore, it is desirable to discover which are the IPT II preexisting conditions that would be responsible for the color to change it in calcificassi. The possibility of achieving a selection of patients in risk classes for the development of calcificassi may dire
Original languageItalian
Publication statusPublished - 2008

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