Document Detail

Mathematical formulation to help identify the patient at risk of ischemic tissue necrosis--a potentially lethal complication of chronic renal failure.
MedLine Citation:
PMID:  8141179     Owner:  NLM     Status:  MEDLINE    
Ischemic tissue necrosis (ITN) has been described as a complication of hyperparathyroidism (HPT) in patients with end-stage renal disease (ESRD) and is associated with a mortality rate of up to 80%. Early recognition of ITN is important but difficult. Optimal treatment is controversial. Based on an analysis of the English literature and a recent clinical experience, a mathematical expression to aid in the identification of high-risk patients (2 x [CaPO(4) - 5] x alkaline phosphatase x PTH ratio) was developed. The values for this expression were calculated in 3 recently reported cases and our case (n = 4). The values were compared with those of a group of 54 hyperparathyroid chronic hemodialysis patients (controls); the mean values were significantly different (p < 0.001). The expression, consisting of 4 easily measured laboratory values, appears to differentiate patients with this complication of ITN from patients with only severe HPT. Ten new additional cases were evaluated using the equation; the sensitivity of the equation was 80% and the specificity 92%, positive predictive value was 66% and the negative predictive value 96%. Long-term validation of this equation is required but it appears to be discriminatory and, thus, promising, given the potentially lethal consequences of ITN.
A Levin; R L Mehta; M B Goldstein
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of nephrology     Volume:  13     ISSN:  0250-8095     ISO Abbreviation:  Am. J. Nephrol.     Publication Date:  1993  
Date Detail:
Created Date:  1994-04-22     Completed Date:  1994-04-22     Revised Date:  2013-04-05    
Medline Journal Info:
Nlm Unique ID:  8109361     Medline TA:  Am J Nephrol     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  448-53     Citation Subset:  IM    
St. Paul's Hospital, Vancouver, B.C., Canada.
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MeSH Terms
Alkaline Phosphatase / blood
Calciphylaxis / diagnosis,  epidemiology*,  etiology
Calcium / blood
Calcium Phosphates / blood
Hyperparathyroidism, Secondary / etiology
Kidney Failure, Chronic / complications*
Models, Theoretical
Parathyroid Hormone / blood
Predictive Value of Tests
Risk Factors
Sensitivity and Specificity
Reg. No./Substance:
0/Calcium Phosphates; 0/Parathyroid Hormone; 0/alpha-tricalcium phosphate; 0/monocalcium phosphate; 0/tetracalcium phosphate; 7440-70-2/Calcium; 97Z1WI3NDX/calcium phosphate; EC Phosphatase; L11K75P92J/dicalcium phosphate anhydrous

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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