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1.
Medicina (B.Aires) ; 84(2): 106-205, jun. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1564773

ABSTRACT

Resumen Introducción : La calcifilaxis es un trastorno vascular grave caracterizado por depósito de calcio en túnica me dia arteriolar, trombosis y necrosis cutánea. Se describió en pacientes con insuficiencia renal (CU), aunque puede producirse en su ausencia (CNU). Sus factores de riesgo están en estudio y su diagnóstico puede ser complejo. Su mortalidad se estimaba en 60-80%, aunque trabajos recientes indican que ha disminuido (40%). Métodos : Estudio retrospectivo entre el 1/1/2011 y el 31/12/2019. Se revisaron los antecedentes, las ca racterísticas clínicas, los hallazgos de laboratorio e histopatológicos, y la evolución de todos los pacientes con diagnóstico de calcifilaxis evaluados en el Hospital Italiano de Buenos Aires. Resultados : Se incluyeron 39 pacientes. El 61.5% (24) eran hombres y 38.5% (15) fueron casos de CNU. De éstos, 82% presentaba hipertensión arterial, 66% obesidad y 46% diabetes. El 49% recibía anticoagulantes dicumarínicos. Todos los pacientes con CNU y 75% con CU presentaron úlceras de fondo necrótico, localizadas con mayor frecuencia en las piernas. En 72% de los casos el diagnóstico histológico se efectuó con una toma de biopsia. En todos, el tratamiento fue multimodal y la mortalidad al año fue de 42%. Conclusión : Observamos una elevada proporción de pacientes con CNU, en relación con lo comunicado en la literatura, y la mitad recibía anticoagulantes di cumarínicos. El diagnóstico histológico se efectuó por biopsia en la mayor parte de los casos, para lo cual la toma quirúrgica de la muestra, la tinción con Von Kossa y la evaluación por un patólogo experto fueron claves.


Abstract Introduction : Calciphylaxis is a serious vascular dis order characterized by calcification of tunica media, in timal hyperplasia, thrombosis, and skin necrosis. It was described in patients with renal failure (UC), although it can occur in its absence (NUC). Its risk factors are under study and its diagnosis can be complex. Over a decade ago, its mortality was estimated at 60-80%. Recent stud ies indicate that it has decreased (40%). Methods : A retrospective study was carried out in the period between January 1, 2011 and December 31, 2019. The past medical record, clinical characteristics, labo ratory and histopathological findings, and evolution of all patients with calciphylaxis evaluated at the Hospital Italiano de Buenos Aires were reviewed. Results : Thirty-nine patients were included. Sixty-one percent were men and 39% were NUC cases. Eighty-two percent had arterial hypertension, 66% obesity and 46% diabetes. Of those, 49% received coumarin anticoagulants. All patients with NUC and 75% with UC presented ulcers with necrosis, located more frequently on the legs. In 72% of the cases the histological diagno sis was made with one biopsy. In all the treatment was multimodal and mortality at one year was 42%. Conclusion : We observed a high proportion of pa tients with NUC, in relation to what is reported in the literature, and that half received vitamin K antagonists. The histological diagnosis was made with one biopsy in most of the cases, as the surgical technique for taking the sample, the Von Kossa staining and the evaluation by an expert pathologist were the key of it.

2.
Medicina (B Aires) ; 84(2): 196-205, 2024.
Article in Spanish | MEDLINE | ID: mdl-38683504

ABSTRACT

INTRODUCTION: Calciphylaxis is a serious vascular disorder characterized by calcification of tunica media, intimal hyperplasia, thrombosis, and skin necrosis. It was described in patients with renal failure (UC), although it can occur in its absence (NUC). Its risk factors are under study and its diagnosis can be complex. Over a decade ago, its mortality was estimated at 60-80%. Recent studies indicate that it has decreased (40%). METHODS: A retrospective study was carried out in the period between January 1, 2011 and December 31, 2019. The past medical record, clinical characteristics, laboratory and histopathological findings, and evolution of all patients with calciphylaxis evaluated at the Hospital Italiano de Buenos Aires were reviewed. RESULTS: Thirty-nine patients were included. Sixtyone percent were men and 39% were NUC cases. Eightytwo percent had arterial hypertension, 66% obesity and 46% diabetes. Of those, 49% received coumarin anticoagulants. All patients with NUC and 75% with UC presented ulcers with necrosis, located more frequently on the legs. In 72% of the cases the histological diagnosis was made with one biopsy. In all the treatment was multimodal and mortality at one year was 42%. CONCLUSION: We observed a high proportion of patients with NUC, in relation to what is reported in the literature, and that half received vitamin K antagonists. The histological diagnosis was made with one biopsy in most of the cases, as the surgical technique for taking the sample, the Von Kossa staining and the evaluation by an expert pathologist were the key of it.


Introducción: La calcifilaxis es un trastorno vascular grave caracterizado por depósito de calcio en túnica media arteriolar, trombosis y necrosis cutánea. Se describió en pacientes con insuficiencia renal (CU), aunque puede producirse en su ausencia (CNU). Sus factores de riesgo están en estudio y su diagnóstico puede ser complejo. Su mortalidad se estimaba en 60-80%, aunque trabajos recientes indican que ha disminuido (40%). Métodos: Estudio retrospectivo entre el 1/1/2011 y el 31/12/2019. Se revisaron los antecedentes, las características clínicas, los hallazgos de laboratorio e histopatológicos, y la evolución de todos los pacientes con diagnóstico de calcifilaxis evaluados en el Hospital Italiano de Buenos Aires. Resultados: Se incluyeron 39 pacientes. El 61.5% (24) eran hombres y 38.5% (15) fueron casos de CNU. De éstos, 82% presentaba hipertensión arterial, 66% obesidad y 46% diabetes. El 49% recibía anticoagulantes dicumarínicos. Todos los pacientes con CNU y 75% con CU presentaron úlceras de fondo necrótico, localizadas con mayor frecuencia en las piernas. En 72% de los casos el diagnóstico histológico se efectuó con una toma de biopsia. En todos, el tratamiento fue multimodal y la mortalidad al año fue de 42%. Conclusión: Observamos una elevada proporción de pacientes con CNU, en relación con lo comunicado en la literatura, y la mitad recibía anticoagulantes dicumarínicos. El diagnóstico histológico se efectuó por biopsia en la mayor parte de los casos, para lo cual la toma quirúrgica de la muestra, la tinción con Von Kossa y la evaluación por un patólogo experto fueron claves.


Subject(s)
Calciphylaxis , Humans , Retrospective Studies , Male , Female , Risk Factors , Middle Aged , Calciphylaxis/therapy , Calciphylaxis/pathology , Calciphylaxis/mortality , Calciphylaxis/diagnosis , Aged , Adult , Aged, 80 and over , Anticoagulants/therapeutic use , Treatment Outcome , Argentina/epidemiology
3.
Rev. cuba. med ; 50(2)abr.-jun. 2011. ilus
Article in Spanish | CUMED | ID: cum-57110

ABSTRACT

La arteriolopatía calcificante urémica es una complicación poco frecuente de la enfermedad renal crónica y se asocia con elevada tasa de mortalidad. A propósito se describió el caso clínico de un hombre de 59 años de edad, con insuficiencia renal crónica terminal que se hallaba en programa de hemodiálisis convencional, en régimen de 3 veces/semana, desde el año 2007. Se le diagnosticó arteriolopatía calcificante urémica grave tras sospecha clínica y biopsia de lesiones cutáneas, con un desenlace fatal. Reconocemos que se requiere un alto índice de sospecha clínica para su diagnóstico precoz y no siempre se asocia a hiperparatiroidismo secundario grave, en su patogenia se imbrican múltiples factores(AU)


The calcifying arteriolopathy is an uncommon complication of chronic renal disease and it is associated with a high rate of mortality. Authors present the clinical case of a man aged 59 presenting with terminal chronic renal failure under a three times/week conventional hemodialysis program from 2007. He was diagnosed with a severe uremic calcifying arteriolopathy after a clinical suspicion and biopsy of cutaneous lesions with a fatal outcome. It is recognized that it is necessary a high rate of clinical suspicion for its early diagnosis and not always it is associated with a severe secondary hyperparathyroidism where multiple factors are involved in its pathogenesis(AU)


Subject(s)
Humans , Male , Adult , Renal Insufficiency, Chronic/complications , Renal Dialysis/adverse effects , Panniculitis/diagnosis , Skin Diseases, Vascular/diagnosis
4.
Rev. cuba. med ; 50(2): 209-215, abr.-jun. 2011.
Article in Spanish | LILACS | ID: lil-615426

ABSTRACT

La arteriolopatía calcificante urémica es una complicación poco frecuente de la enfermedad renal crónica y se asocia con elevada tasa de mortalidad. A propósito se describió el caso clínico de un hombre de 59 años de edad, con insuficiencia renal crónica terminal que se hallaba en programa de hemodiálisis convencional, en régimen de 3 veces/semana, desde el año 2007. Se le diagnosticó arteriolopatía calcificante urémica grave tras sospecha clínica y biopsia de lesiones cutáneas, con un desenlace fatal. Reconocemos que se requiere un alto índice de sospecha clínica para su diagnóstico precoz y no siempre se asocia a hiperparatiroidismo secundario grave, en su patogenia se imbrican múltiples factores


The calcifying arteriolopathy is an uncommon complication of chronic renal disease and it is associated with a high rate of mortality. Authors present the clinical case of a man aged 59 presenting with terminal chronic renal failure under a three times/week conventional hemodialysis program from 2007. He was diagnosed with a severe uremic calcifying arteriolopathy after a clinical suspicion and biopsy of cutaneous lesions with a fatal outcome. It is recognized that it is necessary a high rate of clinical suspicion for its early diagnosis and not always it is associated with a severe secondary hyperparathyroidism where multiple factors are involved in its pathogenesis


Subject(s)
Humans , Male , Adult , Renal Dialysis/adverse effects , Skin Diseases, Vascular/diagnosis , Renal Insufficiency, Chronic/complications , Panniculitis/diagnosis
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