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Trying to figure out if I’m nuts here.
Where I trained for Gen Surg, we did not routinely biopsy to confirm a dx of calciphylaxis. We would recommend labs, calculate Ca x P products, PTH, look for parathyroid hyperplasia and recommend parathyroidectomy as appropriate if medical tx wasn’t working. Generally the approach was to recommend tx for calciphylaxis if the dx was pretty obvious and to only do biopsy in the case of unclear/unusual lesions or maximized medical tx not being effective.
Where I am now for fellowship, the nephrologists/medicine docs want a biopsy to confirm calciphylaxis everytime, usually before they’ve done any of the standard medical workup, and refuse to tx until there is a confirmed tissue dx. And we do it every single time, after doing the appropriate workup to rule out ischemic or vasculitic lesions.
There are several papers out there that I’ve brought up, which recommend against routine biopsy in clear cases of calciphylaxis given the risk in these patients for further tissue loss or infection from a surgical wound.
For those of you involved in this, what is the practice where you are? I’ve given up the fight as a fellow because I don’t get to make the final call, but it drives me crazy. But I’ll be done with fellowship in less than a year and then it WILL be my final call. At this point I plan to advocate against routine biopsy and follow the care pathway I learned in residency. But I’m curious if what I experienced then was just super conservative vs the standards or if where I am now is super aggressive.
Where I trained for Gen Surg, we did not routinely biopsy to confirm a dx of calciphylaxis. We would recommend labs, calculate Ca x P products, PTH, look for parathyroid hyperplasia and recommend parathyroidectomy as appropriate if medical tx wasn’t working. Generally the approach was to recommend tx for calciphylaxis if the dx was pretty obvious and to only do biopsy in the case of unclear/unusual lesions or maximized medical tx not being effective.
Where I am now for fellowship, the nephrologists/medicine docs want a biopsy to confirm calciphylaxis everytime, usually before they’ve done any of the standard medical workup, and refuse to tx until there is a confirmed tissue dx. And we do it every single time, after doing the appropriate workup to rule out ischemic or vasculitic lesions.
There are several papers out there that I’ve brought up, which recommend against routine biopsy in clear cases of calciphylaxis given the risk in these patients for further tissue loss or infection from a surgical wound.
For those of you involved in this, what is the practice where you are? I’ve given up the fight as a fellow because I don’t get to make the final call, but it drives me crazy. But I’ll be done with fellowship in less than a year and then it WILL be my final call. At this point I plan to advocate against routine biopsy and follow the care pathway I learned in residency. But I’m curious if what I experienced then was just super conservative vs the standards or if where I am now is super aggressive.