BONE SCINTIGRAPHY AS A MODALITY TO MONITOR DISEASE ACTIVITY OF CALCIPHYLAXIS IN A PATIENT WITH END-STAGE KIDNEY DISEASE SECONDARY TO DIABETIC NEPHROPATHY

J CHUA1, A HANNAH1, D BARIT1,2, D LANGSFORD1,2
1Northern Health, Epping, Australia, 2University of Melbourne, Parkville, Australia

Background: A diagnosis of calciphylaxis is often made clinically. Bone scintigraphy has been considered as a diagnostic tool for calciphylaxis. We report a case demonstrating the use of bone scintigraphy to diagnose and guide the management of calciphylaxis.
Case Report: A 60-year-old female suffering with pre-dialysis end-stage kidney disease secondary to diabetic nephropathy reported painful subcutaneous nodules in her legs. She was commenced on dialysis due to a concern the lesions were calciphylaxis. Bone scintigraphy performed had findings consistent with calciphylaxis with tracer uptake in subcutaneous tissues, which extended well beyond clinical margins of the nodules.  The patient was commenced on sodium thiosulphate, had increased dialysis frequency with a low calcium dialysate, and had her calcium-containing phosphate binders replaced by non-calcium-based binders.  In two months, the patient‘s subcutaneous nodules reduced and her pain improved and repeat bone scintigraphy demonstrated interval improvement. Six months after diagnosis, the patient had complete resolution of her calciphylaxis both clinically and on repeat bone scintigraphy.  Her calciphylaxis treatment was ceased and she returned to a standard dialysis protocol. Six months later, repeat bone scintigraphy remained normal, indicating no evidence of sub-clinical recurrence.
Conclusions: This case provides further evidence of the potential utility of bone scintigraphy to diagnose calciphylaxis, to determine its severity and help direct management. Bone scintigraphy demonstrated calciphylaxis can extend both spatially and temporally beyond the clinical findings. Further study is warranted to assess the potential use of bone scintigraphy for diagnosis and subsequent management of calciphylaxis.


Biography:
Dr. Justin Chua is a registrar at the Austin and Northern Hospital currently undertaking his advanced training in General Medicine. His aim is to dual-train and specialise in both Nephrology and General Medicine. He has previously worked as an unaccredited renal registrar at the Austin and Northern Hospitals.

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