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关于如何应对钙过敏症患者的十条建议。

Ten tips on how to deal with calciphylaxis patients.

作者信息

Chewcharat Api, Nigwekar Sagar U

机构信息

Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

出版信息

Clin Kidney J. 2025 Apr 9;18(4):sfaf098. doi: 10.1093/ckj/sfaf098. eCollection 2025 Apr.

Abstract

Calciphylaxis is a devastating disease characterized by painful ischemic necrotic skin lesions, primarily affecting patients with end-stage kidney disease. Its incidence has significantly increased over the past decade. Despite substantial morbidity and mortality, the pathogenesis of calciphylaxis remains poorly understood, and currently there are currently no approved treatments available. Diagnosis largely relies on clinical suspicion; skin biopsy may be useful but is not essential, particularly when biopsy risks outweigh benefits. Effective management requires a multidisciplinary approach. Current therapeutic strategies include controlling metabolic bone disease, substituting vitamin K antagonists with alternative anticoagulants, discontinuing calcium and vitamin D supplements, optimizing dialysis protocols, and considering sodium thiosulfate. Promising novel therapies are now emerging. These 10 tips aim to help clinicians avoid common pitfalls and deliver optimal care to patients with calciphylaxis.

摘要

钙过敏是一种严重的疾病,其特征为疼痛性缺血性坏死性皮肤病变,主要影响终末期肾病患者。在过去十年中,其发病率显著上升。尽管钙过敏会导致严重的发病率和死亡率,但其发病机制仍知之甚少,目前尚无获批的治疗方法。诊断很大程度上依赖于临床怀疑;皮肤活检可能有用,但并非必需,尤其是当活检风险大于收益时。有效的管理需要多学科方法。当前的治疗策略包括控制代谢性骨病、用替代抗凝剂替代维生素K拮抗剂、停用钙和维生素D补充剂、优化透析方案以及考虑使用硫代硫酸钠。现在有一些有前景的新疗法正在出现。这10条建议旨在帮助临床医生避免常见的陷阱,并为钙过敏患者提供最佳护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f78f/12209780/a2201222ee22/sfaf098fig1.jpg

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