Calcifilaxis con evolución fatal en paciente en hemodiálisis crónica
Palabras clave:
calcifilaxia, enfermedad renal crónica, hemodiálisis, arteriopatías oclusivas, hiperparatiroidismo
Resumen
La calcifilaxis es una complicación rara pero devastadora de la enfermedad renal crónica terminal (ERCT), especialmente en pacientes bajo tratamiento de hemodiálisis. Se caracteriza por calcificación de la capa media de las arterias, generando isquemia, necrosis y elevado riesgo de sepsis y muerte. Presentamos el caso de una mujer de 65 años con ERCT, secundaria a nefropatía hipertensiva, en hemodiálisis crónica, que desarrolló lesiones cutáneas necróticas extensas en miembros inferiores. Se documentaron alteraciones graves del metabolismo mineral óseo, incluyendo hiperparatiroidismo severo, hipercalcemia e hiperfosfatemia. El diagnóstico de calcifilaxis fue confirmado mediante biopsia. A pesar del tratamiento médico y quirúrgico planificado, la paciente presentó sobreinfección, trombosis de accesos vasculares, tromboembolismo pulmonar, sepsis y muerte por falla multiorgánica. Este caso ilustra la agresividad clínica de la calcifilaxis, su difícil manejo y la necesidad de una intervención precoz y multidisciplinaria.
Citas
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9. Nigwekar SU, Brunelli SM, Meade D, Wang W, Hymes J, Lacson E Jr. Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol [Internet]. 2013 [cited 2024 Sep 18]; 8(7):1162-70. Available from: https://pubmed.ncbi.nlm.nih.gov/23520041/
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11. Vedvyas Ch, Winterfield LS, Vleugels RA. Calciphylaxis: a systematic review of existing and emerging therapies. J Am Acad Dermatol [Internet]. 2012 [cited 2024 Sep 18];67(6): e253-60. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(11)00681-5 Subscription required
12. Singal A, Cowper SE, Ko ChJ, Kroshinsky D, Lipner HI, Robinson-Bostom L, Yosipovitch G, Lipner SR. Part II. Dermatologic manifestations associated with treatment of patients with kidney disease. J Am Acad Dermatol [Internet]. 2025 [cited 2025 Jun 24]:S0190-9622(25)02359-X. Available from: https://pubmed.ncbi.nlm.nih.gov/40543663 Subscription required
13. Floege J, Drüeke TB. Mineral and bone disorder in chronic kidney disease: pioneering studies. Kidney Int [Internet]. 2020 [cited 2024 Sep 18];98(4):807-811. Available from: https://pubmed.ncbi.nlm.nih.gov/32998807/
14. Mazhar AR, Johnson RJ, Gillen D, Stivelman JC, Ryan MJ, Davis CL, Stehman-Breen CO. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney Int [Internet]. 2001 [cited 2024 Sep 18];60(1):324-32. Available from: https://www.kidney-international.org/article/S0085-2538(15)47851-2/fulltext
15. Gallo Marin B, Aghagoli G, Hu SL, Massoud CM, Robinson-Bostom L. Calciphylaxis and kidney disease: A review. Am J Kidney Dis [Internet]. 2023 [cited 2024 Sep 18];81(2):232-9. Available from: https://www.ajkd.org/article/S0272-6386(22)00849-6/fulltext
2. Brandenburg VM, Kramann R, Rothe H, Kaesler N, Korbiel J, Specht P, et al. Calcific uraemic arteriolopathy (calciphylaxis): data from a large nationwide registry. Nephrol Dial Transplant [Internet]. 2017 [cited 2024 Sep 18]; 32(1):126-32. Available from: https://pubmed.ncbi.nlm.nih.gov/26908770/
3. Lal G, Nowell AG, Liao J, Sugg SL, Weigel RJ, Howe JR. Determinants of survival in patients with calciphylaxis: a multivariate analysis. Surgery [Internet]. 2009 [cited 2024 Sep 18];146(6):1028-34. Available from: https://pubmed.ncbi.nlm.nih.gov/19958929/ Subscription required
4. Nigwekar SU, Zhao S, Wenger J, Hymes JL, Maddux FW, Thadhani RI, Chan KE. A Nationally representative study of calcific uremic arteriolopathy risk factors. J Am Soc Nephrol [Internet]. 2016 [cited 2024 Sep 18];27(11):3421-9. Available from: https://pubmed.ncbi.nlm.nih.gov/27080977/
5. Fine A, Zacharias J. Calciphylaxis is usually non-ulcerating: risk factors, outcome and therapy. Kidney Int [Internet]. 2002 [cited 2024 Sep 18]; 61(6):2210-7. Available from: https://www.kidney-international.org/article/S0085-2538(15)48471-6/fulltext
6. Jeong HS, Dominguez AR. Calciphylaxis: Controversies in pathogenesis, diagnosis and treatment. Am J Med Sci [Internet]. 2016 [cited 2024 Sep 18];351(2):217-27. Available from: https://www.amjmedsci.org/article/S0002-9629(15)00030-0/fulltext
7. Brandenburg VM, Kramann R, Specht P, Ketteler M. Calciphylaxis in CKD and beyond. Nephrol Dial Transplant [Internet]. 2012 [cited 2024 Sep 18]; 27(4):1314-8. Available from: https://academic.oup.com/ndt/article-abstract/27/4/1314/1835939?redirectedFrom=fulltext&login=false Subscription required
8. Lum K, Gardner J, Staton M, Dao H Jr. When a biopsy is inadequate in diagnosing calciphylaxis. Skinmed [Internet]. 2022 [cited 2024 Sep 18];20(6):450-1. Available from: https://pubmed.ncbi.nlm.nih.gov/36537680/ Subscription required
9. Nigwekar SU, Brunelli SM, Meade D, Wang W, Hymes J, Lacson E Jr. Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol [Internet]. 2013 [cited 2024 Sep 18]; 8(7):1162-70. Available from: https://pubmed.ncbi.nlm.nih.gov/23520041/
10. Udomkarnjananun S, Kongnatthasate K, Praditpornsilpa K, Eiam-Ong S, Jaber BL, Susantitaphong P. Treatment of calciphylaxis in CKD: A systematic review and meta-analysis. Kidney Int Rep [Internet]. 2018 [cited 2024 Sep 18];4(2):231-44. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6365410/
11. Vedvyas Ch, Winterfield LS, Vleugels RA. Calciphylaxis: a systematic review of existing and emerging therapies. J Am Acad Dermatol [Internet]. 2012 [cited 2024 Sep 18];67(6): e253-60. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(11)00681-5 Subscription required
12. Singal A, Cowper SE, Ko ChJ, Kroshinsky D, Lipner HI, Robinson-Bostom L, Yosipovitch G, Lipner SR. Part II. Dermatologic manifestations associated with treatment of patients with kidney disease. J Am Acad Dermatol [Internet]. 2025 [cited 2025 Jun 24]:S0190-9622(25)02359-X. Available from: https://pubmed.ncbi.nlm.nih.gov/40543663 Subscription required
13. Floege J, Drüeke TB. Mineral and bone disorder in chronic kidney disease: pioneering studies. Kidney Int [Internet]. 2020 [cited 2024 Sep 18];98(4):807-811. Available from: https://pubmed.ncbi.nlm.nih.gov/32998807/
14. Mazhar AR, Johnson RJ, Gillen D, Stivelman JC, Ryan MJ, Davis CL, Stehman-Breen CO. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney Int [Internet]. 2001 [cited 2024 Sep 18];60(1):324-32. Available from: https://www.kidney-international.org/article/S0085-2538(15)47851-2/fulltext
15. Gallo Marin B, Aghagoli G, Hu SL, Massoud CM, Robinson-Bostom L. Calciphylaxis and kidney disease: A review. Am J Kidney Dis [Internet]. 2023 [cited 2024 Sep 18];81(2):232-9. Available from: https://www.ajkd.org/article/S0272-6386(22)00849-6/fulltext
