Calciphylaxis in a patient on hemodialysis. Anatomopathological Clinical Study
DOI:
https://doi.org/10.18004/Keywords:
Calciphylaxis, hemodialysis, uremia, ParaguayAbstract
Arterial calcification was described by Bryant and While in 1898 in patients with chronic renal failure. In 1962 Selye called it calciphylaxis. 1 to 4% of patients on hemodialysis suffer from it. Calciphylaxis or calcific uremic arteriopathy is an entity with poor prognosis and high mortality, of nearly 80 percent. It is a rare and severe disorder characterized by calcification of the medial layer of small arterioles leading to ischemia and necrosis. The term calciphylaxis implies a systemic and anaphylactic reaction that was first observed in animal models. Calcific uremic arteriolopathy was proposed to describe the phenomenon in chronic renal failure, but the term Calciphylaxis is still used. Vascular calcification of the arterioles compromises skin, subcutaneous tissue and even muscles that ulcerate and get over infected and if not healing can lead to septicemia and the death of the patient. The diagnosis is anatomopathological. We report a case of a 47 years old woman, with diabetes type 2, with two years on hemodialysis, with dermal nodule in hypogastrium and mammary region, indurated, painful, necrotic, ulcerated whose pathology confirmed Calciphylaxis. It discusses the most important aspects of this pathology, with emphasis on diagnosis and risk factors for prevention.
References
1. Adrogué HJ, Frazier MR, Zeluff B, Suki WN. Sistemic Calciphylaxis revisited. Am J Nephrol
1981; 1: 177
2. Kent RB 3rd, Lyerly RT. Systemic calciphylaxis. South Med J 1994; 87:278.
3. Lorenzo Sellares V, Rodríguez Portillo M, Cannata Andía J, Torres Ramírez A. Alteraciones
metabolismo fosfocálcico. En: Manual de nefrología. Madrid: Editorial Harcourt 2002.p. 503-18
4. Fine A, Zacharias J. Calxiphylaxis is usually non-ulcerating: risk factors, outcome and therapy. Kidney Int 2002; 61:2210.
5. Angelis M, Wong LL, Myers SA y cols: Calciphylaxis in patients on hemodialysis: a prevalence study. Surgery 122: 1083-1089. 1997.
6. SELEY H, GABBIANI G, STREBEL R. Sensitization to calciphylaxis by endogenous
parathyroid hormone. Endocrinology 1962; 71:554.
7. Seyle H. Calciphylaxis. Chicago, IL, University of Chicago Press, 1962
8. Don BR, Chin AI. A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies. Clin Nephrol 2003; 59:463.
9. Hayden MR, Tyagi SC, Kolb L, et al. Vascular ossification-calcification in metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and calciphylaxis-calcific uremic
ateriolopathy: the emerging role of sodium thiosulfate. Cardiovasc Diabetol 2005; 4:4.
10. Price PA, Omid N, Than TN, Williamson MK. The amino Bisphosphonate ibandronate
prevents calciphylaxis in the rat at doses that inhibit bone resorption. Calcif Tissue Int 2002;
71:356.
11. Shiraishi N, Kitamura K, Miyoshi T, et al. Successful treatment of patient with severe calcific uremic arteriolopathy (calciphylaxis) by etiodronatw disodium. Am J Kidney Dis 2006; 48:151.

