A painful skin rash in a patient with Stage V chronic kidney disease.

Abstract

This case highlights the importance of early identification of skin lesions in patients with Stage V CKD, whether on dialysis or not. It illustrates the relevant differential diagnosis and the investigations required to establish a diagnosis. Most importantly, it illustrates that calciphylaxis may occur in a pre-dialysis patient with normal levels of calcium and phosphate and minimal elevation of PTH levels, a combination that is poorly recognized in the literature. Although the management of calciphylaxis is largely supportive, with little evidence of benefit from medical or surgical therapy, it is likely that outcome will be improved by earlier diagnosis. An International Calciphylaxis Registry has been established to increase knowledge and data collection in this condition, to create a tissue bank comprising of blood, tissue and DNA from patients with calciphylaxis and to support future research. This may be accessed at http://www.calciphylaxis.org.uk/.