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Es exhibit an increased propensity to vascular and genitourinary calcification. 10,11 opn and mgp double knockout mice exhibit dramatically increased levels of vascular calcification such that they die from calcific vessel rupture. 12 it is therefore tempting to speculate that these mechanisms may become dysfunctional in uraemic patients and thereby contribute to the development of cua as well as the burden of cardiovascular disease carried by the dialysis population as a whole. canadian viagra discounts viagra for sale viagra online generic viagra online viagra discount viagra for sale buy viagra online buy cheap viagra buy cheap viagra cheap generic viagra 13 it is well documented that an elevated acute phase response as indicated by an elevated c reactive protein level is a strong predictor of mortality. 14 it is therefore pertinent that ahsg/fetuin is a negative acute phase reactant with levels falling in states of chronic inflammation. 15 the circulating levels of ahsg/fetuin were found to be lower in dialysis populations compared to controls and was an independent risk factor for patient death. 16 clinical presentation clinically, calciphylaxis usually presents with violaceous mottling, livedo reticularis or as erythematous plaques, nodules or papules. When the condition is non-ulcerating the clinical findings may be confused, as in our patient, with cellulitis. These lesions are typically intensely painful and firm to touch. Ninety percent of lesions are found on the lower extremities. 2 calciphylaxis may affect the distal limbs (calves and forearms) or may be more proximal and involve the thighs, buttocks or abdomen. 4 not uncommonly, the genitals may be affected or it may be acral, affecting the fingers and toes. It may also involve other organs including muscles (causing a painful myopathy), heart, joints, lungs, pancreas and the eye. 4 the differential diagnosis includes peripheral vascular disease, atheroembolic disease, cryoglobulinaemia and vasculitis. Diagnosis the diagnostic gold standard is a tissue biopsy that demonstrates the typical histological features of calciphylaxis. However, it must be recognised that this should be avoided if possible as there is a significant risk in performing biopsies of suspicious lesions as ulceration commonly ensues. Other investigations should include measurement of serum calcium, phosphate and pth levels as well as assay of coagulation factors, cryoglobulins and a vasculitis screen including assay for anca. Arterial duplex doppler scanning and even peripheral an. Forwarding to Tank's Portal....
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