recovery of renal function with resolution of pulmonary oedema.
COMMENTIn elderly diabetic patients with renal cholesterol atheroembolism, a common precipitant is manipulation of atherosclerotic vessels during vascular surgery or angiography. It can also result from thrombolytic and anticoagulant therapy, sometimes after a considerable delay1. Spontaneous cholesterol embolism is uncommon-found by Cross2 in 1.9% of serial necropsies, always in patients over 60 years of age. The clinical features are varied and make diagnosis difficult. Risk factors for renal cholesterol atheroembolism are advanced age (mean 66 years), hypertension, coronary atherosclerosis and renal impairment3. Spontaneous renal atheroembolism often leads to progressive decline in renal function, early dialysisdependence and high mortality3; however, renal function can recover4. Flash pulmonary oedema often points to underlying atheromatous renal artery occlusion, and we suspect that this was present in our patient. Regarding treatment, there is some evidence that a statin can stabilize atherosclerotic plaques, reduce the propensity for atheroembolism and thus preserve renal function5.Recurrent spontaneous cholesterol atheroembolism, characterized here by short-lived episodes of acute renal failure and pulmonary oedema, does not seem to have been described previously. This possibility should be considered in any elderly diabetic patient with established atherosclerotic disease who presents with impaired renal function and pulmonary oedema.
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