Off-campus Pacific University users: To download campus access theses and dissertations, please log into our proxy server with your PUNet ID and password.

Non-Pacific University users: Please talk to your librarian about requesting this thesis or dissertation through interlibrary loan.

Theses or dissertations that have a specific embargo period indicated below will not be available to anyone until the date indicated.

Date of Graduation

8-2007

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Clara LaBoy, MS PA-C

Abstract

Context: Calciphylaxis (Cal-Cee-Fah-Lax-Is) is a rare but deliberating disease that affects mostly patients with End-Stage Renal Disease (ESRD) on Dialysis or have had recent renal transplant. The disease has however been seen in people without ESRD. Calciphylaxis has been reported in patients with clinical diagnosis of breast carcinoma treated with chemotherapy, alcoholic liver cirrhosis, cholangiocarcinoma, Crohn's disease, rheumatoid arthritis, and systemic lupus erythematosus with or without chronic kidney disease.

Objective: To promote understanding ofthe condition by developing a report that blends a current literature review with a case study, to assist medical personnel to identify the disease early and to best manage it. Calciphylaxis is mainly cutaneous but can systemic. This study focuses on the cutaneous calciphylaxis.

Data Sources, Study Selection and Data Extraction: The patient's chart was reviewed. The MEDLINE and OVID databases were searched for articles published between 1976 and June 2007 using database specific keywords. Bibliographies of the retrieved articles were searched, along with Cochrane Library and relevant websites. Reference textbooks were searched for further background and supporting information. The retrieved literature was reviewed for pertinent information.

Data Synthesis: Calciphylaxis affects 1-4% of the people with ESRD, it is characterized by small vessel mural calcification with or without endovascular fibrosis, extravascular calcification and vascular thrombosis, leading to tissue ischemia. The pathogenesis of calciphylaxis is poorly understood, making diagnosis difficult especially in non-ESRD patients. At present there is no clear first line treatment recommendation. However a few medications have shown promising results including Sodium Thiosulfate, Cinacalcet, Pamidronate, Etidronate disodiurn, Tissue Plasminogen Antigen and prednisone. Parathyroidectomy has also been used. On the other hand this is a disease with a high mortality rate, 60-80%.

Conclusion: Calciphylaxis is a rare but deliberating disease that can be managed with early recognition and treatment. Treatment is directed at the underlying cause. Pain management and wound care remains the cornerstone of patient care. Sodium Thiosulfate has been used successively in several patients with and without a high calcium/phosphate product.

Comments

The digital version of this project is currently unavailable to off-campus users; however, it may be requested via interlibrary loan by eligible borrowers from Pacific University Library. Pacific University Library is a free lender. (Library Use: NL)

Share

COinS