Q J Med 1988; 67: 319-341
© 1988 Association of Physicians
research-article |
Symmetric Gangrene of the Extremities in Late Renal Failure: A Case Report and Review of the Literature
Departments of Medicine *Departments of Pathology, Ninewells Hospital and Medical School Dundee DD1 9SY
Address correspondence to Dr. S. P. Wilkinson, Department of Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland.
Medial calciflcation of arteries is common in chronic renal failure. We report on a patient with extensive calciflcation of the arterial media who development symmetrical acral gangrene and severe cardiae failure shortly after cadaveric renal transplantation. At necropsy, the medial calciflcation was found to be accompained by extensive intimal proliferation and multiple antemortem fractures, some healing by callus formation. such medial calciflcation, which is similar to Monckeberg's sclerosis, affected all systemic arteries except the aorta, pulmonary artery and transplanted renal artery. Six years before this terminal illness he had undergone total parathyrioidectomy for osteitis fibrosa associated with ruptured tendons.
We review previous reports of patients with the syndrome of acral gangrene in azotaemic renal failure and discuss the histopathological features and pathogenesis in realation to the unusual features of our patient.