Calcific uremic arteriolopathy: Presentation of a clinical case with conservative medical management

Abstract

Background: The calcifying uremic arteriolopathy or calciphylaxis is a rare, life-threatening syndrome that affects almost exclusively patients with kidney failure and dialysis, characterized by vascular calcification of small and medium-caliber arteries, with subsequent proliferation, fibrosis, and thrombosis that eventually lead to necrosis and skin ulcers. It is associated with end-stage kidney disease and kidney transplantation, with a prevalence of 1-4% of patients with chronic kidney failure. Treatment is specialized based on a hyperbaric chamber and parathyroidectomy to induce healing. Description of the clinical case: 42-year-old female, recruited in the nephrology outpatient clinic at the Honduran Social Security Institute in 2017, with a history of arterial hypertension and chronic nephropathy, who underwent a kidney transplant in 1998 which was subsequently failed in a hemodialysis program and conservative management since 2005. The patient developed ecchymotic lesions on the trunk and ulcers at sites of subcutaneous nodules that became superinfected, developing signs of a systemic inflammatory response. Laboratory tests showed hyperphosphatemia, parathormone 3518 pg / ml, calcium-phosphorus product 73.5. Given the lack of surgical management (parathyroidectomy) and hyperbaric chamber in the institution, conservative treatment was established based on daily antibiotics, analgesics, and hemodialysis, which presented an improvement in the clinical picture; however, without resolution of her underlying condition of calciphylaxis. Conclusions: Conservative management in the case of patients with calciphylaxis is an available treatment option with a good response in patients with close follow-up.