N GAVRILESCU1, A HANNAH1, D BARIT1, D LANGSFORD1
1Northern Health, Melbourne, Australia
Aim: To systematically review the role of serial bone scintigraphy in non-invasive diagnosis and monitoring of calciphylaxis.
Background: Calciphylaxis is a life-threatening complication of end stage renal failure. Bone scintigraphy has previously been demonstrated to have a sensitivity of 89-97% (95% confidence interval (CI) of 65-98%) and specificity of 97% (95% CI 83-99%) for the diagnosis of biopsy-proven calciphylaxis.
Methods: Consent and ethics approval was obtained for the 2 case reports. Scopus and Medline databases were systematically searched using the terms “calciphylaxis” and either “bone scintigraphy”, “bone scan” or “technetium”. 191 research papers were identified between 1976 and July 2020. Articles were excluded if they did not contain cases of patients with calciphylaxis who were imaged with bone scintigraphy. A total of 22 primary research papers were identified involving 72 patients, 11 of which had serial imaging.
Results: We report 2 new cases of calciphylaxis treated with sodium thiosulfate in a 65 year old female pre-dialysis and a 52 year old female on haemodialysis. In the first case serial scintigraphy was used to determine treatment duration. In the second it identified non-response to cinacalcet and warfarin cessation at 3 months and prompted the introduction of sodium thiosulfate. Review of the 11 patients from the literature demonstrated the benefit of serial imaging in identifying non-adherence or non-response to treatment, predicting prognosis, and comparing treatment modalities.
Conclusion: Serial bone scintigraphy can have a useful impact on clinical decision-making in the management of calciphylaxis by guiding treatment duration and identifying radiological evidence of non-response.
Dr Nichita is a General Medicine Advanced Trainee interested in pursuing Nephrology Advanced training. He has an interest in General and Interventional Nephrology, as well as Medical Obstetrics.