In real-world clinical practice, there is substantial variability in the diagnosis and treatment of CUA. There is usually only modest derangement of bone and mineral parameters at the time of diagnosis. Death is common. The presence of CVD and use of warfarin may influence clinical outcome after diagnosis of CUA.

The successful treatment of advanced calcium deposition by aggressive immune ablation underscores the contribution of SLE-mediated inflammation to soft-tissue calcification syndromes.

High FGF23 levels may be a marker for parathyroid gland hyperplasia in HD patients. Acute reductions in neither PTH nor renal phosphate during dialysis correlated with PTH suppression.

Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a complex syndrome of deranged mineral metabolism and vascular calcification leading to tissue ischemia that primarily occurs in end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). We report a case illustrating a temporal relationship between long-term warfarin anticoagulation and development of CUA in a patient with pre-dialysis chronic kidney disease (CKD) who progressed to ESRD. Serial 99mTc-methylene diphosphonate bone scintigraphy documented the evolution of metastatic CUA over a 5-month period following HD initiation. Given the temporality demonstrated here via imaging, we speculate that warfarin’s influence on vitamin K-dependent matrix Gla protein function coupled with risk factors associated with ESRD led to the development of metastatic CUA.

Background: Post-hepatectomy liver failure (PHLF) is a major complication with a high mortality rate after hepatectomy. Although computed tomography (CT) volumetry (CTV) is commonly used to determine the volume of the future liver remnant (FLR), it does not inform the quality of FLR. 99mTc-Mebrofenin scintigraphy is used to assess the FLR function and assist surgeons with preoperative decision-making process such as two-staged approach with portal vein/hepatic vein embolization, upfront hepatectomy or palliative management. Methods: A prospectively maintained hepatobiliary database at Western Health (2020-2021) identified 11 patients who received mebrofenin for operative workup. Results: Nine patients consented for the study. Four patients were diagnosed with cholangiocarcinoma, followed by four colorectal liver metastases and one hepatocellular carcinoma. All patients were male with a median age of 55 years . The initial median FLR percentage on CTV was 15.1% ) and a median mebrofenin uptake rate of 2.14%/min/m 2 (n = 5, IQR 1.55-2.15). 89% (8/9) and 80% (4/5) had FLR volume and mebrofenin uptake rate below the cut-off values for PHLF. Eight patients underwent portal vein and/or hepatic vein embolisation which improved the uptake rate to 3.26%/min/m 2 (IQR 2.82-3.45). Three patients underwent right hemihepatectomy and four exploratory laparotomies due to intraoperative findings of metastases. No patients developed PHLF. Two had disease progression. Conclusions: This is the first Australian case series of Mebrofenin scan to our knowledge, which highlights that it can assist a surgeon in assessing the FLR function in addition to volumetry to avoid the likelihood of PHLF.