Calcific Uremic Arteriolopathy in End Stage Renal Disease: Pathophysiology and Management

Background: Calcific uremic arteriolopathy (CUA), a debilitating condition with high morbidity and mortality, is most commonly seen in patients with kidney disease. The pathophysiology of CUA is multifactorial, leading to a disruption in the balance between factors that promote and those that inhibit calcification, although the exact pathophysiological mechanisms of CUA remain to be elucidated. Methods: This review provides an overview of the pathophysiology, clinical presentation and diagnosis, and treatment of CUA. Results: Diagnosis of CUA requires a high degree of suspicion; skin biopsy with histological examination remains the gold standard to confirm the diagnosis. Treatment of CUA requires a multidisciplinary approach. Conclusion: With a high degree of clinical suspicion and early diagnosis, an aggressive multifactorial treatment approach involving optimal wound management, minimization/avoidance of risk factors and precipitating causes, and correction of calcium-phosphorus abnormalities can significantly improve patient outcomes.