Clinical Management of Nonuremic Calcific Arteriolopathy: A Report of Three Cases

Abstract

Introduction. Calcific arteriolopathy involves the deposition of insoluble calcium salts in the vasculature and soft tissues, leading to ischemia, thrombosis, and cutaneous necrosis. Calcific arteriolopathy is commonly associated with ESRD but can also occur outside of ESRD, known as NUC. Objective. This article reviews the clinical management and outcomes of 3 cases of non-uremic calcific arteriolopathy. Materials and Methods. This case series describes the clinical presentation and successful treatment of NUC in a community hospital–based outpatient wound center in southeastern Wisconsin. Factors presumed to be involved included chronic kidney disease–associated mineral bone disorder, dysregulation and deficiencies of the inhibitors of vascular calcifications, autoimmune dysfunction, and chronic inflammation. All 3 patients received multimodal treatment with wound hygiene, pain management, and infection control. In addition to these interventions, case 2 received NLFU. Results. All 3 patients displayed increased tolerance of compression and debridement and successfully epithelialized with no discernible effect on long-term function or quality of life. Wound infection occurred in each case. The mean overall healing time was 20 weeks. Conclusion. The study findings suggest that successful management of NUC can be achieved using IV STS, early and aggressive infection treatment, pain control, and wound hygiene. In patients with NUC, NLFU may be an appropriate adjunct to expedite healing.