Metal deposition in calcific uremic arteriolopathy - 07/08/11
Abstract |
Background |
Calcific uremic arteriolopathy (CUA) is an often fatal disease that affects patients with end-stage renal disease. Although animal studies support a role for metals in the pathogenesis of CUA, metal accumulation in human tissue has not been previously evaluated.
Objective |
We sought to evaluate metal deposition in CUA.
Methods |
Twelve histologically proven cases of CUA were identified from our dermatopathology database. Five skin biopsy specimens from patients with chronic kidney disease exposed to gadolinium contrast but without CUA were used as controls. Quantification of metals including iron, aluminum, and gadolinium in the lesional skin was performed using inductively coupled mass spectrometry.
Results |
Seven patients had documented exposure to gadolinium-based contrast in the 2 years before CUA. Three of them had concurrent nephrogenic systemic fibrosis. Highly significant quantities of iron (P = .03) and aluminum (P = .0002) were detected in CUA specimens compared with controls. Significant amounts of gadolinium were present in several CUA biopsy specimens.
Limitations |
Observational, retrospective study design and small sample size are limitations.
Conclusion |
Tissue iron and aluminum content is increased in CUA. A significant amount of gadolinium is also present in some CUA specimens. Based on animal studies that strongly implicate metals in the pathogenesis of CUA, our data suggest that metal deposition should be considered in the pathogenesis of human CUA.
Le texte complet de cet article est disponible en PDF.Key words : calcific uremic arteriolopathy, calciphylaxis, gadolinium, metals, nephrogenic systemic fibrosis
Abbreviations used : CUA, NSF, PTH
Plan
The project, as commissioned at the University of Arkansas, was supported by grant No. T32DK061921 from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr High’s work in the area of metal deposition in tissue, commissioned at the University of Colorado and Colorado School of Mines, is made possible by a Career Development Award in Medical Dermatology bestowed by the Dermatology Foundation. |
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Conflicts of interest: None declared. |
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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes And Digestive And Kidney Diseases or the National Institutes of Health. |
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Reprints not available from the authors. |
Vol 61 - N° 1
P. 73-79 - juillet 2009 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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