EMINEM Case #1 Answers & Discussion
EMiNEM Case #1: Answers and Discussion
A. Warfarin should be discontinued
Ideally this is true since warfarin use is strongly associated with CUA. We have not been able to convince this patient to stop because of the access issues.
B. Parathyroidectomy is indicated
The PTH levels have not been particularly high in this patient. Furthermore, there are case reports of new onset or worsening CUA post parathyroidectomy
C. Sodium thiosulphate should be discontinued
This is clearly unknown. The Sodium thiosulphate does not seem to be preventing the development of new lesions, yet it may be stabilizing pre-existing lesions. There is no clear consensus here.
D. Hyperbaric oxygen therapy should be arranged
This is what we elected to do – in addition to local measures and continuation of aggressive dialysis sodium thiosulphate and non-calcium phosphate binders.
E. Urgent renal transplantation is required
Given this patient’s precarious vascular access this would be a real option, yet new onset or aggravated CUA has been reported post renal transplantation