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Cutaneous Calcification in Patients With End-Stage Renal Disease
A Regulated Process Associated With In Situ Osteopontin Expression
Jacqueline Rivet, MD;
Celeste Lebbé, MD, PhD;
Pablo Urena, MD;
Florence Cordoliani, MD;
Franck Martinez, MD;
Anne C. Baglin, MD;
Pierre Aubert, MD;
Selim Aractingi, MD, PhD;
Pierre Ronco, MD;
Philippe Fournier, MD;
Anne Janin, MD, PhD
Arch Dermatol. 2006;142:900-906.
Background Cutaneous calcification, or calcinosis cutis (CC), is found in approximately 1% of patients with end-stage renal disease (ESRD) undergoing chronic dialysis. While the pathogenesis is not well understood, it may be similar to those for medial and intimal vascular calcifications, which are actively regulated processes.
Observation In a retrospective study of 9 patients, the role of an active calcification process leading to CC was assessed by the immunohistochemical detection of osteopontin, which is a regulator of osseous and extra-osseous calcification processes. Calcinosis cutis was associated with female sex, vascular comorbidity, inconstant secondary hyperparathyroidism, and elevated levels of plasma calcium-phosphorus product. Six patients had a favorable outcome after the lowering of plasma calcium levels during dialysis or after parathyroidectomy.
Conclusions Calcinosis of the vascular media of subcutaneous vessels was the most common histologic feature and was always associated with osteopontin staining, suggesting that CC is a regulated process. Moreover, to our knowledge, extravascular staining of osteopontin in sweat glands, nerves, and macrophages was demonstrated for the first time in this study.
Author Affiliations: Departments of Pathology (Drs Rivet and Janin), Dermatology (Drs Lebbé and Cordoliani), and Nephrology (Dr Martinez), AP-HP, Saint-Louis Hospital, INSERM U728 (Drs Rivet and Janin) and INSERM U349 (Dr Urena), University Paris VII, Departments of Dermatology (Dr Aractingi) and Nephrology (Dr Ronco), AP-HP, Tenon Hospital, and Department of Nephrology, Hospital Ouest Parisien (Dr Fournier), Paris France; Department of Nephrology, Clinic of Orangerie, Aubervilliers, France (Dr Urena); and Department of Pathology, Foch Hospital, Suresnes, France (Dr Baglin).
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