Atheroembolic renal disease

Abstract

Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often aff ects other organs, such as the skin, gastrointestinal system, and brain. Although the disease can develop spontaneously, it usually develops after vascular surgery, catheterisation, or anticoagulation. The systemic nature of atheroembolism makes diagnosis diffi cult. The classic triad of a precipitating event, acute or subacute renal failure, and skin lesions, are strongly suggestive of the disorder. Eosinophilia further supports the diagnosis, usually confi rmed by biopsy of an aff ected organ or by the fundoscopic fi nding of cholesterol crystals in the retinal circulation. Renal and patient prognosis are poor. Treatment is mostly preventive, based on avoidance of further precipitating factors, and symptomatic, aimed to the optimum treatment of hypertension and cardiac and renal failure. Statins, which stabilise atherosclerotic plaques, should be off ered to all patients. Steroids might have a role in acute or subacute progressive forms with systemic infl ammation.

Cholesterol embolization syndrome: report of two cases

“…Advanced atherosclerosis is the most important independent risk factor for the development of CES. [1,2] The present patients had all risk factors except diabetes mellitus. CES may, rarely, occur spontaneously, but often follows invasive cardiovascular procedures such as cardiac catheterization, coronary or peripheral angiography, cardiovascular surgery, cardiopulmonary resuscitation, and anticoagulant and thrombolytic treatments.…”

“…One of the most important characteristic features of CES is AKI with poor prognosis causing high incidence of irreversible organ damage. [1,2] Two cases of CES that developed after peripheral angiography are described in the present report.…”

“…Following arteriolar obstruction by the emboli, multinuclear cell and eosinophil infiltration, and secretion of vasospastic mediators occur, leading to further ischemia and exacerbation of organ damage. [1,[6][7][8] Organs most commonly involved in CES are the kidneys, liver, spleen, pancreas, gastrointestinal tract, and adrenal glands. Mortality is as high as 81% in cases of multiple organ involvement.…”

Membranous Nephropathy Associated with Atheroembolism

“…Renal involvement is present in 25 to 50 percent of cases, typically with a subacute kidney injury observed within a few weeks or more than several weeks after a possible inciting event [2], often associated with peripheral eosinophilia [3]. Other features include hypocomlementemia, which has been reported in 39% of patients in one study [4].…”

Renal Denervation: Unde Venis et Quo Vadis?

“…However, there are currently no clinical studies with larger numbers of patients proving this influence on the circadian blood pressure regulation in patients with renal insufficiency. Since there is a risk of further worsening of renal function in these patients as a result of contrast-induced nephropathy or acute renal failure due to interventionassociated cholesterol embolism [65,66], patients with chronic renal diseases and a GFR < 45 ml/min/1,73 m 2 should currently not be treated with renal denervation outside of controlled studies.…”