Revisiting the death of Louis XIV: a nephrological perspective

Louis XIV died in 1715 at the age of 76 years. His death was attributed by contemporaneous accounts to dry gangrene secondary to peripheral arterial disease. Several clinical features described in these accounts may also be interpreted through alternative modern nephrological frameworks, including chronic kidney disease and calciphylaxis. We performed a critical reappraisal of contemporaneous medical and lay descriptions of King’s terminal illness, integrating these sources with contemporary knowledge of chronic kidney disease and calciphylaxis. The work followed a hypothesis-driven approach, explicitly acknowledging the inherent limitations of retrospective diagnosis in historical medicine. Historical descriptions report progressive, painful ischemic lesions of the lower limb evolving toward necrosis and death from sepsis. Louis XIV presented several conditions currently recognized as calciphylaxis risk factors, including obesity, diabetes mellitus, and possibly chronic kidney disease. When examined through a modern nephrological perspective, features such as a 10-day delay between pain onset and lesion appearance, lesion localization, pain severity, and the absence of traumatic origin are compatible with calciphylaxis. Based on a critical reinterpretation of contemporaneous accounts and modern pathophysiological knowledge, this work explores the possibility that Louis XIV’s terminal illness is compatible with chronic kidney disease and calciphylaxis. Although retrospective confirmation is impossible, calciphylaxis remains a plausible hypothesis, highlighting the potential under-recognition of chronic kidney disease and its complications in historical cases.