CASE REPORT Calcific Uremic Arteriolopathy Treated with Cinacalcet, Paricalcitol, and Autologous Growth Factors Despoina Kakagia, Pelagia Kriki, Elias Thodis, Athanasios Roumeliotis, and Vassilios Vargemezis Background: Calcific uremic arteriolopathy is an uncommon cutaneous ischemic necrotizing disease, most commonly associated with renal disease and hyperparathyroidism, bearing a high mortality rate. Objective and Method: A case of a 57-year-old female renal patient with hyperparathyroidism who was successfully treated with combined paricalcitol and cinacalcet systemically, while autologous growth factors were locally applied, is herein presented. Result and Conclusion: The combination of cinacalcet and paricalcitol is a reliable alternative to parathyroidectomy in patients with calcific uremic arteriolopathy and hyperparathyroidism. Meticulous de ´ bridement of necrotic tissues is essential and application of autologous growth factors promotes healing. Ante ´ ce ´ dents: L’arte ´ riopathie ure ´ mique calcifiante est une ne ´ crose ische ´ mique cutane ´ e non fre ´ quente, le plus souvent associe ´ea ` une ne ´ phropathie et a ` l’hyperparathyroı ¨die et dont le taux de mortalite ´ est e ´ leve ´. Objectif et me ´ thode: Pre ´ senter le cas d’une femme de 57 ans souffrant de ne ´ phropathie et d’hyperparathyroı ¨die, qui a suivi un traitement syste ´ mique re ´ ussi d’une combinaison de paricalcitol de cinacalcet, alors que les facteurs de croissance autologues ont e ´ te ´ applique ´ s localement. Re ´ sultat et conclusion: La combinaison de cinacalcet et de paricalcitol est une alternative fiable a ` la parathyroı¨dectomie chezles patients souffrant d’arte ´ riopathie ure ´ mique calcifiante et a ` d’hyperparathyroı ¨die. Le de ´ bridement me ´ ticuleux des tissus ne ´ crotiques est crucial; l’application locale de facteurs de croissance autologues favorise la gue ´ rison. C ALCIFIC UREMIC ARTERIOLOPATHY (CUA), previously termed calciphylaxis, is a progressive ischemic necrosis of the skin and subcutaneous adipose tissue and represents an uncommon yet severe and life- threatening complication of end-stage renal disease (ESRD), bearing a 60 to 80% mortality rate. 1,2 Pre- disposing factors include white race, female sex, obesity, malnutrition, hypoalbuminemia, hypotension, diabetes, liver disease, increased serum calcium-phosphorus pro- duct, protein S and C deficiencies, local trauma, and warfarin therapy. 1–5 Increased concentrations of calcium and phosphorus, transformation of vascular smooth muscle cells into osteoblast-like cells, increased extracel- lular deposition of Carich vesicles, resulting in ossification, calcification and cellular death, are pathways involved in the pathogenesis of CUA, which remains obscure. Furthermore, endothelial calcification, fibrosis, and necro- sis are observed. 2 Treatment of CUA remains controversial and targets the elimination of biochemical risk factors, pain, and wound management. More frequent hemodialysis, use of low-calcium dialysate, sodium thiosulfate, parathyroidect- omy, and parathyroid hormone (PTH) suppressors are treatment options aiming to reduce calcium-phosphorus product, whereas hyperbaric oxygen and autologous growth factors may be used to accelerate wound healing after meticulous de ´bridement. 3–5 Herein a patient with CUA, parathyroid hyperplasia, and adenoma is presented. The patient was successfully treated with systemic paricalcitol and cinacalcet and local application of autologous growth factors. Case Report A 58-year-old, white, nonobese lady presented with a week’s history of multiple painful, firm, subcutaneous plaques of different sizes in the inner and posterior sides of both thighs and two necrotic, ulcerated lesions of 2.8 3 2.6 cm in the inner surface of the right calf (Figure 1). The patient From the Departments of Plastic and Reconstructive Surgery and Nephrology, Democritus University Hospital, Alexandroupolis, Greece. Address reprint requests to: Despoina Kakagia, MD, PhD, FEBOPRAS, 7 P. Kirillou Str, 68100 Alex/polis, Greece; e-mail: despoinakakagia @yahoo.com. DOI 10.2310/7750.2011.10052 # 2011 Canadian Dermatology Association Journal of Cutaneous Medicine and Surgery, Vol 15, No 2 (March/April), 2011: pp 121–124 121