Diagnostics and techniques: Edited by Maarten W. TaalCalcific uraemic arteriolopathy: an updateRogers, Natasha Ma,b; Coates, Patrick Toby Ha,b,cAuthor Information aTransplantation Immunology Laboratory and Department of Medicine, Australia bDepartment of Nephrology and Transplantation Services, University of Adelaide, The Queen Elizabeth Hospital (TQEH) Campus, Woodville, Australia cCentre for Stem Cell Research, University of Adelaide, Adelaide, Australia Correspondence to Dr Patrick Toby H. Coates, Department of Nephrology and Transplantation Services, TQEH, 28 Woodville Road, Woodville, SA 5011, Australia Tel: +61 88 2226666; fax: +61 88 2226026; e-mail: [email protected] Current Opinion in Nephrology and Hypertension: November 2008 - Volume 17 - Issue 6 - p 629-634 doi: 10.1097/MNH.0b013e32830f4566 Buy Metrics Abstract Purpose of review Calcific uraemic arteriolopathy (CUA) or calciphylaxis is a rare but important cause of morbidity and mortality in patients with chronic kidney disease. The prevalence of CUA is increasing in patients with renal failure, and the condition is also being recognized in nonuraemic patients. Recent findings There has been increasing understanding of the molecular basis of vascular calcification, in particular on the important role of the uraemic microenvironment in the factors implicated in the differentiation of vascular smooth muscle cells into osteoblasts. New options for treatment of hyperphosphataemia and secondary hyperparathyroidism in patients with chronic kidney disease have become available in the last few years and these have begun to be used in patients with CUA. These include bisphosphonates, newer noncalcium/nonaluminium-containing phosphate binders and case reports of use of cinacalcet. Other treatments for CUA that are not targeted directly at calcium/phosphate homeostasis include hyperbaric oxygen and the antioxidant cation chelator sodium thiosulphate. Summary Clinicians managing patients with CUA should consider a combination approach of treating deranged calcium/phosphate with newer therapeutic agents and promoting wound healing with other older modalities such as hyperbaric oxygen and sodium thiosulphate infusions. Randomized controlled trials for treatments in CUA are still lacking. © 2008 Lippincott Williams & Wilkins, Inc.