Metal deposition in calcific uremic arteriolopathy

• Published in: Journal of the American Academy of Dermatology 2009-07, Vol.61 (1), p.73-79
• Main Authors: Amuluru, Lavanya, MD, High, Whitney, MD, Hiatt, Kim M., MD, Ranville, James, PhD, Shah, Sudhir V., MD, Malik, Bilal, MD, Swaminathan, Sundararaman, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aluminum - metabolism; Arterial Occlusive Diseases - chemically induced; Arterial Occlusive Diseases - metabolism; Arterioles - pathology; Biological and medical sciences; calcific uremic arteriolopathy; calciphylaxis; Calciphylaxis - chemically induced; Calciphylaxis - metabolism; Contrast Media - adverse effects; Dermatology; Female; gadolinium; Gadolinium - adverse effects; Gadolinium - metabolism; Humans; Iron - metabolism; Kidney Failure, Chronic - complications; Male; Medical sciences; metals; Middle Aged; Nephrogenic Fibrosing Dermopathy - complications; Nephrogenic Fibrosing Dermopathy - metabolism; nephrogenic systemic fibrosis; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Retrospective Studies; Skin - metabolism; Skin Diseases - chemically induced
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2009.01.042

Background Calcific uremic arteriolopathy (CUA) is an often fatal disease that affects patients with end-stage renal disease. Although animal studies support a role for metals in the pathogenesis of CUA, metal accumulation in human tissue has not been previously evaluated. Objective We sought to evaluate metal deposition in CUA. Methods Twelve histologically proven cases of CUA were identified from our dermatopathology database. Five skin biopsy specimens from patients with chronic kidney disease exposed to gadolinium contrast but without CUA were used as controls. Quantification of metals including iron, aluminum, and gadolinium in the lesional skin was performed using inductively coupled mass spectrometry. Results Seven patients had documented exposure to gadolinium-based contrast in the 2 years before CUA. Three of them had concurrent nephrogenic systemic fibrosis. Highly significant quantities of iron ( P = .03) and aluminum ( P = .0002) were detected in CUA specimens compared with controls. Significant amounts of gadolinium were present in several CUA biopsy specimens. Limitations Observational, retrospective study design and small sample size are limitations. Conclusion Tissue iron and aluminum content is increased in CUA. A significant amount of gadolinium is also present in some CUA specimens. Based on animal studies that strongly implicate metals in the pathogenesis of CUA, our data suggest that metal deposition should be considered in the pathogenesis of human CUA.