ABSTRACT
Contexto: Paciente de 38 anos foi encaminhado por ordem judicial para ambulatório de saúde ocupacional de hospital público terciário com queixa de dor difusa em membros inferiores, superiores, coluna e bacia, além de dificuldade na deambulação. Trazia imagens de ressonância magnética e tomografia com sinais de osteosclerose/osteonecrose em diferentes ossos (tíbia, fêmur, úmero, osso da bacia). Havia sido atendido pela equipe de clínica médica do mesmo hospital e realizado biópsia de crista ilíaca, que evidenciou infarto ósseo e grande quantidade de alumínio ósseo. Tem histórico laboral de atividade na produção de alumínio durante quatro anos, em mineradora do estado do Maranhão. Objetivos: O presente trabalho tem como objetivo revisão na literatura de possíveis causas ocupacionais em distúrbios ósseos, e identificar elementos técnico-científicos que permitam relacionar a deposição óssea de alumínio com as alterações clínico-radiológicas do caso em questão. Métodos: Foi realizada revisão de literatura baseada em publicações nas principais bases de pesquisa (PubMed, SciELO, Lilacs), além de avaliação de etapas de beneficiamento do alumínio na indústria mineradora. Resultados: Por meio da constatação da exposição do trabalhador a subprodutos químicos do beneficiamento do alumínio metálico, que, sabidamente podem causar fluorose óssea, e a associação desta doença com os achados de exame radiológico, bem como sintomatologia apresentada por este trabalhador, é possível estabelecer nexo ocupacional. Conclusão: A sintomatologia apresentada pelo trabalhador, bem como suas alterações de exame de imagem e anatomopatológico, permitem inferência de causalidade entre a exposição a compostos de fluoreto e criólita e seu distúrbio ósseo.
Context: A 38 year old patient was referred by court order for occupational health medical service of tertiary public hospital complaining of diffuse pain in lower and upper limbs, spine and pelvis, and walking difficulty. Magnetic resonance imaging and tomography signs of osteosclerosis/osteonecrosis in different bones (tibia, femur, humerus, hip bone). He was seen by the medical clinic of the same hospital and some procedures have been performed, such as iliac crest biopsy, which revealed bone infarction and a large amount of aluminum bone. This patient has worked for four years in aluminum production, in Maranhão, Brazil. Objectives: This paper aims to review the literature of possible occupational causes for bone disorders and identify technical and scientific elements that may allow to relate the bone aluminum deposition with clinical and radiological changes of the case. Methods: For this purpose, we performed a literature review based on publications in major research bases (PubMed, SciELO, Lilacs), and evaluation stages of processing of aluminum in the mining industry. Results: Through the observation of the worker exposure to chemical byproducts from the processing of aluminum metal, which is known to cause skeletal fluorosis, and the association of this disease with radiological findings and symptoms presented by this paper, it is possible establish relationship between his occupational activity and the diasease. Conclusion: The symptoms presented by the worker, as well as their changes of imaging and pathologic examination, allow inference of causality between exposure to fluoride and cryolite compounds and their bone disorder.
Subject(s)
Osteonecrosis/etiology , Occupational Exposure , Fluorine Compounds , Aluminum/adverse effectsABSTRACT
Polyvinyl alcohol liquid PVA1 was used as the organic carrier for Hydroxylapatite-gel [Hap-gel] composite. PVA1 has the ability to form a nano- hydroxylapatite polyvinyl alcohol composite gel which has a wide range of uses in different environmental and medical applications. Prepared Hap-gel is known to have a very similar composition to human bone and is used as a substitute for bones in compound fractures and artificial dentures. In this work prepared HAP- gel was exposed to a high ionizing radiation electron beam [5 kilo Gray] and an aqueous solution containing aluminum ions [Al[+]]. Some investigations were done to illustrate the effect of radiation exposure and aluminum contamination on prepared Hap-gel. Energy dispersive X-ray analysis [EDx] showed that the electron beam used caused an obvious increase in the calcium ions [Ca[++] content of the prepared Hap-gel from 60% to 65.69% with a prominent decrease in phosphorus ions [P[+] content from 40% to 34.31% in addition to an increase in the Ca/P ratio from 1.5 to 1.91. Exposure of the pre-irradiated Hap-gel samples to aluminium ions [Al[+] resulted in a noticeable decrease in Ca[+] content from 65.69 atomic% to 32.14% atomic% and a further noticeable decrease in P+content from 34.31% atomic% to 13 atomic% as well as an increase in the Ca/P ratio from 1.91 to 2.47. The levels for the original prepared Hap-gel were Ca[++]; 60 atomic% and P+; 40 atomic%. It was deduced that exposure of the Hap-gel to Al+had a further damaging effect on the pre-irradiated Hap-gel composition in addition to the damaging effect that the electron beam used induced on the samples. it could be concluded that electron beams and Al+ have an injurious effect on human bone tissue taking into consideration the similarity in composition between Hap-gel and bones. Therefore, this study could be beneficial in the field of osteoporosis research and assist the understanding of the effects of radiation such as that of electron beams and some pollutants such as aluminium present in running water on the health of human bone tissue
Subject(s)
Tomography, X-Ray Computed/statistics & numerical data , Radiation, Ionizing , Calcium/adverse effects , Phosphorus/adverse effects , Aluminum/adverse effectsABSTRACT
Introdução: A hipótese de que os efeitos do alumínio em células humanas podem ter implicações clínicas tem sido levantada há algum tempo, especialmente no que concerne ao câncer de mama. As evidências laboratoriais mostrando altos níveis de alumínio nos tecidos da mama e os efeitos biológicos conhecidos sobre esse metal não são suficientes para estabelecer uma relação causal entre a exposição ao alumínio e o risco aumentando para o desenvolvimento do câncer de mama. O objetivo deste estudo foi estabelecer a concentração de alumínio nas áreas centrais e periféricas de tumores de mama, assim como na área glandular normal da mama e correlacionar esses achados com a instabilidade dos genes ERBB2, C-MYC e CCND1 e a aneuploidia dos cromossomos que contêm estes genes. Métodos: Para este estudo foram incluídas 176 mulheres com diagnóstico de carcinoma invasor de mama, com tumores maiores de 1cm3, sem quimioterapia neoadjuvante, operadas enter 2008 e 2010 no Hospital da Mulher Prof. Dr. José Aristodemo Pinotti - Centro de Atenção Integral à Saúde da Mulher (CAISM) - UNICAMP. Para a análise da concentração de alumínio intracelular, amostras de 150 pacientes foram consideradas viáveis; para a análise da instabilidade genômica em função da concentração de alumínio, 118 amostras foram consideradas viáveis, definindo o espaço amostral de cada um dos artigos apresentados. As amostras das áreas centrais e periféricas dos tumores de mama e das áreas glandulares normais da mama foram obtidas. A quantificação do alumínio contido nos tecidos da mama foi feita através da técnica de Espectrometria de Absorção Atômica em Forno de Grafite (GFAAS). Uma lâmina de Tissue Microarray (TMA), contendo as amostras de tumor e tecido normal foi utilizado para a realização da técnica de FISH para acessar o status dos genes ERBB2, C-MYC e CCND1 e dos centrômeros dos seus respectivos cromossomos 17, 8 e 11. Os dados clínico-patológicos foram obtidos dos prontuários de pacientes...
Introduction: It has long been hypothesized if the effects of aluminum on human cells may have clinical implications, especially regarding to breast cancer. The current laboratorial evidence showing higher levels of aluminum in breast tissues and the known biological effects of this metal, are not sufficient to establish a causal relationship between aluminum exposure and increased risk of developing breast cancer. The objective of this study was to establish the aluminum concentration in the central and peripheral areas of breast tumors as well as in normal glandular area of the breast and to correlate these findings with the instability of ERBB2, C-MYC and CCND1, and aneuploidy of chromosomes harboring these genes. Methods: This study included 176 women diagnosed with invasive breast carcinoma with tumors larger than 1cm3 without neoadjuvant chemotherapy, operated between 2008 and 2010 at the Women's Hospital Professor. Dr. José Aristodemo Pinotti - Centro de Atenção Integral à Saúde da Mulher (CAISM) - UNICAMP. To analyze the intracellular concentration of aluminum, samples from 150 patients were considered viable; for the analysis of genomic instability as a function of the concentration of aluminum, 118 samples were considered viable. These figures define the sample of each of the two articles that this PhD thesis comprises. Evaluation of tissue aluminum content was carried out using Graphite Furnace Atomic Absorption Spectrometry (GFAAS). A TMA slide containing the tumor and normal samples was used in FISH assays to assess ERBB2, C-MYC and CCND1 and the respective chromosomes 17, 8 and 11 centromeres status. Clinicopathological data were obtained from patients' records. Results: The average aluminum content found in breast was 1.88 mg/kg in the central tumor areas, 2.10 mg/ kg in the peripheral tumor areas and 1.68 mg/ kg in the normal tissue areas...
Subject(s)
Humans , Female , Aluminum/adverse effects , Breast Neoplasms , Genomic Instability , Cyclin D1 , Genes, mycABSTRACT
A presente tese é composta de três artigos sobre os impactos ao ambiente e àsaúde coletiva da cadeia produtiva do alumínio no Brasil. O primeiro artigo versa sobreos impactos produzidos ao longo das etapas produtivas do alumínio primário, a partir daextração da bauxita, até a fabricação final. O texto realça e discute os processos deexternalidades ambientais, inerentes ao processo, que são responsáveis pela degradaçãoambiental e pela produção de danos à saúde coletiva, como os relacionados aosacidentes de trabalho ou aqueles associados às emissões de gases do efeito estufa. Osegundo artigo faz uma discussão sobre o modelo de inserção do Brasil no mercadomundial do alumínio a partir dos referenciais teóricos da economia espacial e daecologia política. A inserção do Brasil no mercado global de alumínio é apresentada soba lógica da subordinação ao grande capital; uma lógica em que os territórios se adequamcomo suportes produtivos de commodities, agrícolas ou metálicas. A produção eexportação de commodities reproduz uma Divisão Internacional do Trabalho marcadapela participação submissa dos territórios produtivos, que sofrem os efeitos colaterais damodernização, com impactos ao ambiente e à saúde da população. O terceiro ederradeiro artigo, é um estudo de caso sobre os impactos da mineração de bauxita nomunicípio de Itamarati de Minas, em Minas Gerais. No texto são apresentadas ascaracterísticas do processo de extração de bauxita e sua articulação aos impactosambientais e a diminuição da qualidade de vida das famílias que tradicionalmentepraticam uma pequena agricultura familiar. O artigo discute ainda, questões quecolocam em risco a sustentabilidade socioambiental da região, como a própria atividademineral que, além do desflorestamento, geram impactos como a redução da qualidadedos solos, erosão e assoreamento; e o avanço da monocultura do eucalipto que nosúltimos anos vêm substituindo a vegetação original de áreas mineradas. Por fim,conclui-se que a inserção do país no mercado global de alumínio tem sido construída apartir da geração de pesados impactos ao ambiente nos territórios e à saúde coletiva depopulações; no caso do município de Itamarati de Minas, torna-se patente a necessidadede se pensar um modelo de desenvolvimento alternativo para a agricultura familiar; ummodelo baseado em formas sustentáveis de produção, democrático e socialmente justo.
Subject(s)
Humans , Aluminum/economics , Aluminum/adverse effects , Aluminum/poisoning , Environment , Environmental Policy , Mining , Social Justice , Accidents, Occupational/statistics & numerical data , Exportation of Products , Aluminum Industry/economics , Occupational Health , Socioeconomic FactorsABSTRACT
Objetivo Se investigó la presencia de aluminio (Al) y de patologías respiratorias en el tracto respiratorio bajo de personas que habían residido en Ciudad de México por un tiempo mínimo de dos años. Métodos Se obtuvo 250 muestras de tejido respiratorio (lóbulos pulmonares, nódulo linfático peribronquial, bronquios e hilio), durante la autopsia médico legal de 36 individuos. Para la cuantificación de Al se utilizó plasma de inducción acoplado (ICP -OES) a la espectrofotometría de absorción atómica previo a lo cual las muestras fueron sometidas a un proceso de secado, trituración y digestión. Resultados Se identificaron 13 diferentes patologías, solo tres de ellas: enfisema pulmonar, bronquitis y antracosis, se correlacionan con la presencia de Al, elemento distribuido en concentraciones muy variables (rango:2,7 a 836,1 microgramos de Al por gramo de tejido seco (ì g Al/g ts). En lóbulos, bronquios e hilio la cantidad de Al encontrada fue mucho menor que la encontrada en nódulos peribronquiales, siendo la diferencia estadísticamente significativa. El análisis multivariado por conglomerados mostró que la muestra estaba conformada por tres clases de individuos, agrupados de acuerdo a la cantidad y distribución del Al en el tracto respiratorio bajo, a la edad, tiempo de residencia en la ciudad de México y presencia de patologías. Conclusión Se postula que el Al encontrado en el tracto respiratorio bajo de residentes de ciudad de México proviene del aire; la cantidad y el patrón de distribución dependen del tiempo y del lugar de residencia y al depositarse puede provocar enfermedades respiratorias.
Objective Investigating the presence of aluminium (Al) and respiratory pathologies in the lower respiratory tract of people who had lived in Mexico City for a minimum of two years. Methods 250 respiratory tissue samples were obtained from pulmonary lobes, lymph nodes, bronchial and hilum regions during 36 individuals' autopsies. Inductively coupled plasma optical emission spectrometry (ICP-OES) was used for quantifying Al; the samples has been previously dried, ground and digested. Results 13 different pathologies were identified but only three of them (pulmonary emphysema, bronchitis and anthracosis) were correlated with the presence of Al, an element being distributed in very variable concentrations (range: 2,7 to 836,1 micrograms of Al per gram of dry tissue (ì g Al/g ts)). The amount of Al found in lobes, bronchial and hilum regions was much smaller than that found in lymph nodes; such difference was statistically significant. Multivariate analysis by conglomerates revealed that the sample consisted of three classes of individuals, grouped according to the amount and distribution of Al in the lower respiratory tract, age, time spent living in Mexico City and the presence of pathologies. Conclusions The Al found in the lower respiratory tract of residents of Mexico City would thus seem to have come from the air. The amount of Al and its distribution pattern depended on the time and place of residence and can lead to respiratory illness.
Subject(s)
Humans , Aluminum/adverse effects , Aluminum/analysis , Lung Diseases/chemically induced , Lung/chemistry , Mexico , Urban HealthABSTRACT
A elevada toxicidade do alumínio para pacientes com insuficiência renal está muito bem documentada na literatura. A ação tóxica deste elemento é tão elevada que um controle anual dos níveis de alumínio sérico dos pacientes submetidos regularmente ao tratamento de hemodiálise é exigida pela Agência Nacional de Vigilância Sanitária (ANVISA). Devido à ubiquidade do aluminio, a análise requer cuidados especiais com relação à contaminação. Neste trabalho são abordados os aspectos mais importantes, desde a coleta até a quantificação do alumínio propriamente dita, para evitar fontes externas de contaminação e conduzir análise com êxito. Os cuidados necessários tornam-se relevantes devido ao baixo limite que coloca o paciente em risco. Níveis de Al acima de 30ug/L já caracterizam intoxicação, e determinam tratamento com agente quelante para redução do nível de Al sérico. Como este tratamento não é isento de efeitos colaterais, é muito importante que resultados confiáveis seja obtidos na análise do alumínio sérico.
Subject(s)
Humans , Aluminum/adverse effects , Aluminum/blood , Aluminum/toxicity , Blood Chemical Analysis , Chronic Kidney Disease-Mineral and Bone Disorder , Dementia , Renal Dialysis , Blood/radiation effectsABSTRACT
Aluminum is a nonessential metal to which humans are frequently exposed. A small amount of the metal is present in diet and it is poorly absorbed through the GI tract. To our knowledge, no reports on dietary toxicity exist in the literature; however, excessive intake may cause adverse effects. In the recent years, its hazardous effects have been under investigation. Toxic effects on behavior, erythropoiesis, nervous system, and endocrine hormones, as well as calcium metabolism have been observed in experimental models. In addition, effects of Aluminum on memory, endocrine glands, reproduction, gastric secretion, immune system and hematopoeisis have been studied. In this review article, some of these studies are reviewed, discussed and compared. Although aluminum is considered to be a nonessential element, since its safety range has not been determined yet, special attention should be paid to individuals who are at risk
Subject(s)
Humans , Aluminum/adverse effects , Models, TheoreticalABSTRACT
Se presentan 2 pacientes de un grupo de 6 trabajadores que tenían en común haber laborado en la actividad de metalización (recubrimiento de superficies metálicas con aluminio pulverizado con una antorcha), los cuales durante 8 años, como promedio, compartieron largas jornadas. Se describe la forma de inicio de la enfermedad y su evolución, muy grave y rápida en el primer caso, y algo más solapada en el segundo, pues ambos fallecieron. Se detallan además las condiciones de trabajo y de las adecuaciones que sobre éstas se realizan antes y después de diagnosticados los casos. Resultado del análisis conjunto de los exámenes realizados a los trabajadores, así como su historia ocupacional, antecedentes personales y familiares, se concluye que se trató de 2 casos afectados por aluminosis
Subject(s)
Aluminum/adverse effects , Occupational Exposure/adverse effects , Pneumoconiosis/etiologyABSTRACT
BACKGROUND: Anaemia is a cardinal feature of chronic renal failure and classically it is normochromic normocytic. Hypochromic anaemia in these patients is often attributed to iron deficiency. AIM: This study was aimed to find the contribution of aluminium in causation of anaemia in CRF patients. METHODS: Dialysis dependent patients of chronic renal failure with adequate dietary intake (> 1500 Cals/day) and no apparent source of blood loss were evaluated for type of anaemia. (During period of this study centre didn't have reverse osmosis plant for water treatment). Evaluation included upper GI endoscopy, complete hemogram, serum proteins, serum iron, total iron binding capacity, and bone marrow iron status. For aluminium evaluation serum aluminium levels were done. RESULTS: Sixty-four patients were evaluated for type of anaemia. Mean age of patients was 41.19 years (15-76 years) with male:female ratio 2.3:1. Classical normochromic picture was seen in 28.5% while rest had hypochromic picture. On bone marrow aspiration study two patients had zero iron stores while all others had normal/excessive iron stores. In 10 patients with hypochromic picture, mean serum aluminium levels were 170 micrograms/L (30-310 micrograms/L). CONCLUSIONS: This study highlights the high prevalence of hypochromic anaemia in patients with adequate dietary intake and aluminium overload in Indian CRF patients.
Subject(s)
Adult , Aluminum/adverse effects , Anemia, Iron-Deficiency/etiology , Female , Hemodialysis Solutions , Humans , Kidney Failure, Chronic/complications , MaleABSTRACT
A large number of maize genotypes are currently being evaluated to determine the effect of environmental stress caused by the aluminum found in cerrado soils on meiotic behavior. In the present study we report the occurrence of cell fusion followed or not by chromatin degeneration in meiocytes of some plants of an inbred line of maize grown on acid and corrected soil in the Brazilian central plateau. The results suggest the absence of any soil effect on the irregularities observed since the number of affected plants was higher among those grown on corrected soil. The possible causes of these irregularities and their influence on male sterility are discussed.
Subject(s)
Aluminum/adverse effects , Cell Fusion , Chromatin/pathology , Soil Pollutants/adverse effects , Zea mays/cytology , Zea mays/genetics , Genotype , MeiosisABSTRACT
Chromosome instability consists of chromosome abnoprmalities as multiple breaks in in metaphase chromosomes in syndromes of chromosaome instability such as fanconi's anemia (FA) which is mainly characaterized by bone marrow aplasia; some cases progress to acute leukemia. FA is a hereditary disease with recessive and monogenic transmission. This pair of mutated genes is related to chromosome fragility and therefore is responsible for the inefficiency of DNA repair. In normal individuals, these genes are assumed to be expressed normally, but their products ara insufficient to perform DNA repair when the intensity of the polluting agent lelads to exposure above basal levels. In the present study, the bone marrow of four patients with different hematologic diseases was submitted to cytogenetic analysis. Two had aplastic anemia, and one bad lymphoblastic leukemia. These patients were from towns unb the Amazon Region where the mercuri used for gold prospecting and the substances used and/or released in aluminium mining have been introduced into the environment. The last patient had fanconi's anemia and was used as a model in the discussion of the results. The cytogenetic findings were similar for all patients, the major ones being chromosome fragmentation and pulverization. In view of these findings, we believe that chromosome fragility, observed in the first three patients, presumably was induced by environmental pllutants
Subject(s)
Humans , Male , Child , Adult , Chromosome Aberrations/chemically induced , Hematologic Diseases/genetics , Environmental Pollutants/adverse effects , Aluminum/adverse effects , Anemia, Aplastic/genetics , Bone Marrow , Fanconi Anemia/genetics , Leukemia, Lymphoid/genetics , Mercury/adverse effectsABSTRACT
Este estudio comparó la dosis de radiación, la calidad radiográfica, la densidad y el contraste de las películas radiográficas del grupo D (ULTRASPEED-Eastman Kodak Co.) que fueron radiografiadas con filtración adicional de 1,5 mm. y 2,0 mm. de aluminio, con y sin barrera simuladora de la tela blanda. Se formaron 4 grupos, cada uno con 5 películas en los cuales los factores geométricos y de exposición siguieron a un determinado patrón. El tiempo de exposición utilizado fue de 1 segundo, conforme recomendó el fabricante de la película, para una distancia de 40 cm. Después del procesamiento manual de las películas, se realizaron lecturas fotodensitométricas y se tabularon los datos. Se verificó la transformación hiperbólica de los datos originales y el estudio de los valores de "a"(densidad) y "b"(contraste) alcanzados por la regresión linear de los datos transformados. Nuestros resultados demostraron una reducción del 24 por ciento de la dosis de radiación cuando se utilizaba la filtración adicional de 2,0 mm. más la simulación de la tela blanda (barrera de agua), en relación con la filtración de 1,5 mm. Los test estadísticos presentaron diferencias significantes con p < 0,05 para densidad rafiográfica e igualdad de las muestras para los valores de contraste radiográfico. Concluímos entonces que se recomienda la filtración con 2,0 mm. de aluminio para potenciales de 65kVp en estas condiciones experimentales, puesto que no ocurre pérdida de contraste radiográfico, sino una disminución de la dosis de exposición alrededor del 24 por ciento. La filtración adicional de la mayoría de los aparatos de rayos X odontológicos que operan en ese potencial en Brasil, debe ser alterada para 2,00 mm., considerando el principio ALARA
Subject(s)
Aluminum/adverse effects , Dose-Response Relationship, Radiation , Radiation Protection/methods , X-Rays/adverse effects , Absorptiometry, Photon , Quality Control , Radiation Exposure , Radiography, Dental/standardsABSTRACT
Se realiza un estudio descriptivo para evaluar los distintos factores de riesgo en el ambiente laboral de las areas y puestos de trabajo de metalizacion con aluminio en la Central Electronuclear "Juragua"; asimismo,se examinan clinicamente a los 36 trabajadores presentes que laboraban o que lo habian hecho en algun tiempo, por mas de 1 ano, en esta actividad. Los resultados arrojan que los sistemas de ventilacion de las diferentes areas son deficientes, pues en la mayoria de los puestos de trabajo se encontraron concentraciones de polvo de aluminio por encima de 5 mg/m3 (concentracion promedio admisible). Estas concentraciones oscilaron entre 4 y 86,5 mg/m3 y los operarios fueron los mas expuestos a ellas. En el estudio medico se observo que 18 casos (50 por ciento), mostraron algun tipo de alteracion clinica en su aparato respiratorio, los mas frecuentes fueron los hallazgos en los rayos X de torax. Las principales y masseveras afectaciones fueron encontradas en los individuos de mayor exposicion y en los que ocupan el puesto de operario de metalizacion, pues de un total de 10 examinados, 7 (70 por ciento) presentaban afectaciones. En 1 caso se detecto neumoconiosis
Subject(s)
Humans , Male , Aluminum/adverse effects , Occupational Diseases/diagnosis , Risk FactorsSubject(s)
Humans , Animals , Mice , Rats , Aluminum/toxicity , Erythropoiesis/drug effects , Renal Insufficiency, Chronic/complications , Aluminum/adverse effects , Aluminum/metabolism , Anemia/etiology , Anemia/physiopathology , Bone and Bones/drug effects , Bone and Bones/metabolism , Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Chronic Kidney Disease-Mineral and Bone Disorder/physiopathology , Deferoxamine/therapeutic use , Erythropoietin/antagonists & inhibitors , Food Additives , Aluminum Hydroxide/adverse effects , Osteomalacia/etiology , Osteomalacia/physiopathology , Hemodialysis Solutions/adverse effectsSubject(s)
Humans , Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Aluminum Hydroxide/adverse effects , Chronic Kidney Disease-Mineral and Bone Disorder , Aluminum/adverse effects , Renal Dialysis/adverse effects , Dialysis Solutions/adverse effects , Hemodialysis Solutions/adverse effectsABSTRACT
La calcificación metastática ocurre frecuentemente en paciente con insuficiencia renal crónica en hemodiálisis de mantenimiento (HN). Existe dos variedades de la misma: a) calcificación visceral: pulmón, corazón, riñones, cerebro; b) calcificación no visceral: 1-arteria, ojo, piel; 2-tumoral: articular, periarticular y tejido subcutáneo. Referimos el caso de una paciente en quien se observó la infrecuente asociación de ambos tipos de calcificación. Se presentan la evolución radiológica y las tomografías computadas que se efectuaron para realizar el diagnóstico y diagnósticos diferenciales y los datos clínicos que acompañaron esas manifestaciones. Sobre la base de este caso clínico se realizan los mecanismos fisiopatogénicos de la calcificación visceral y no visceral. Se destaca la progresiva evolución del hiperparatiroidismo secundario como responsable del aumento del producto fosfocálcico en una paciente que no cumplía con la medicación instituída, lo que motivó la progresión de las calcificaciones no viscerales. Se sugiere como posible tratamiento el control de los niveles de fosfatemia a fin de disminuir el depósito de sales de calcio y sus complicaciones en el área no visceral y la necesidad de tener en cuenta a la calcificación visceral en el diagnóstico diferencial de la enfermedad cardíaca o respiratoria del paciente en HM