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Sequential Bone Scintigraphy and the Evolution of Warfarin-Mediated Calcific Uremic Arteriolopathy

Authors
  • Santos, Peter W.
  • Wetmore, James B.
Type
Published Article
Journal
Case Reports in Nephrology and Dialysis
Publisher
S. Karger AG
Publication Date
Mar 01, 2021
Volume
11
Issue
1
Pages
78–86
Identifiers
DOI: 10.1159/000512611
PMID: 33829045
PMCID: PMC7991460
Source
Karger
Keywords
License
Green
External links

Abstract

Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a complex syndrome of deranged mineral metabolism and vascular calcification leading to tissue ischemia that primarily occurs in end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). We report a case illustrating a temporal relationship between long-term warfarin anticoagulation and development of CUA in a patient with pre-dialysis chronic kidney disease (CKD) who progressed to ESRD. Serial <sup>99m</sup>Tc-methylene diphosphonate bone scintigraphy documented the evolution of metastatic CUA over a 5-month period following HD initiation. Given the temporality demonstrated here via imaging, we speculate that warfarin’s influence on vitamin K-dependent matrix Gla protein function coupled with risk factors associated with ESRD led to the development of metastatic CUA.

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