Atheroembolic renal disease with rapid progression and fatal outcome

Faria, Bernardo; Vidinha, Joana; Pêgo, Cátia; Garrido, Jesús; Lemos, Sérgio; Lima, Carla; Sorbo, Giovanni Del; Gomes, Edgar Lorga; Carvalho, Teresa; Loureiro, Paulo R. A.; Sousa, Tânia

doi:10.1007/s10157-010-0363-3

Cited by 4 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One and two-year patient survival rates of 87% and 75%, respectively, have been reported while the 4-year survival rate drops to 52% [60]. Mortality is high, varying from 64% to 81% [64,65,66]. The major cause of death is cardiovascular disease [67].…”

Section: Outcomementioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

View full text Add to dashboard Cite

Renal disease caused by cholesterol crystal embolism (CCE) occurs when cholesterol crystals become lodged in small renal arteries after small pieces of atheromatous plaques break off from the aorta or renal arteries and shower the downstream vascular bed. CCE is a multisystemic disease but kidneys are particularly vulnerable to atheroembolic disease, which can cause an acute, subacute, or chronic decline in renal function. This life-threatening disease may be underdiagnosed and overlooked as a cause of chronic kidney disease (CKD) among patients with advanced atherosclerosis. CCE can result from vascular surgery, angiography, or administration of anticoagulants. Atheroembolic renal disease has various clinical features that resemble those found in other kidney disorders and systemic diseases. It is commonly misdiagnosed in clinic, but confirmed by characteristic renal biopsy findings. Therapeutic options are limited, and prognosis is considered to be poor. Expanding knowledge of atheroembolic renal disease due to CCE opens perspectives for recognition, diagnosis, and treatment of this cause of progressive renal insufficiency.

show abstract

Section: Outcomementioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

View full text Add to dashboard Cite

show abstract

“…It is often difficult to diagnose unless kidney biopsy is performed, and it is precipitated by acute or subacute renal failure and is associated with poor prognosis . In view of our findings, patients with asymptomatic retinal emboli may benefit from not only general cardiovascular workup but also assessment of renal function to detect this potentially fatal complication . Future longitudinal studies are needed to determine whether retinal emboli could predict risk of renal disease and its prognosis.…”

Section: Discussionmentioning

confidence: 84%

“…8,20 In view of our findings, patients with asymptomatic retinal emboli may benefit from not only general cardiovascular workup but also assessment of renal function to detect this potentially fatal complication. 21 Future longitudinal studies are needed to determine whether retinal emboli could predict risk of renal disease and its prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population

et al. 2017

View full text Add to dashboard Cite

IMPORTANCE To our knowledge, population-based data on retinal emboli are limited in Asia. Besides its associations with traditional cardiovascular risk factors and stroke, associations between retinal emboli and renal disease and function remain unclear.OBJECTIVE To examine the prevalence of and risk factors for retinal emboli in a large, contemporary, multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study was conducted from 2004 to 2011 and included a total of 10 033 Chinese, Malay, and Indian persons aged 40 to 80 years residing in the general communities of Singapore. Analyses were performed from November 2016 to February 2017. INTERVENTIONS OR EXPOSURESRetinal emboli were ascertained from retinal photographs obtained from both eyes of all participants according to a standardized protocol. Age-standardized prevalence of retinal emboli was calculated using the 2010 Singapore adult population. Risk factors were assessed from comprehensive systemic and ophthalmic examinations, interviews, and laboratory investigations. MAIN OUTCOMES AND MEASURES Retinal emboli.RESULTS Of the 10 033 participants, 9978 (99.5%) had gradable retinal photographs. Of these, 5057 (50.7%) were female, and 3375 (33.8%) were Indian. We identified 88 individuals (0.9%) with retinal emboli; the overall person-specific, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort (0.98%), followed by the Chinese (0.73%) and Malay (0.44%) cohorts (P = .03). In multivariable-adjusted analysis, factors associated with prevalent retinal emboli included older age (per 5-year increase; odds ratio [OR], 1.22; 95% CI, 1.05-1.41), Indian ethnicity (compared with Malay ethnicity; OR, 3.58; 95% CI, 1.95-6.60), hypertension (OR, 1.95; 95% CI, 1.03-3.70), chronic kidney disease (OR, 2.05; 95% CI, 1.15-3.64), creatinine level (per SD increase; OR, 1.13; 95% CI, 1.05-1.21), glomerular filtration rate (per SD increase; OR, 0.67; 95% CI, 0.51-0.86), and history of stroke (OR, 3.45; 95% CI, 1.70-6.99). CONCLUSIONS AND RELEVANCEBased on 88 individuals among 9978 participants of 3 major Asian ethnic populations, retinal emboli were most commonly seen in Indian persons and associated with conventional cardiovascular risk factors, stroke, and chronic kidney disease. Therefore, its presence may signal vascular embolic event and damage not only in the brain but also in the kidneys. If these data are confirmed in longitudinal studies, they would suggest that persons with retinal emboli may require both general cardiovascular and renal assessment.

show abstract

“…If we look at the anatomical pictures of this kind of renal damage, we can easily understand way it may progress to chronic irreversible renal failure (Fig. 4) (35), while the progression of only hemodynamic damage or even acute ischemic tubular damage such as that attributable to contrast media, toward an irreversible end-stage renal disease, would be much less explicable -nephrologically speaking. In fact, it has been argued also that CIN by itself might be a progression factor for worsening renal and systemic prognosis (36)(37)(38).…”

Section: The Spectrum Of Possible Clinical Entities To Be Enclosed Wimentioning

confidence: 99%

Pitfall in nephrology: contrast nephropathy has to be differentiated from renal damage due to atheroembolic disease

Stratta¹,

Bozzola²,

Quaglia³

2012

View full text Add to dashboard Cite

In a setting regarding millions of patients and millions of dollars/year, in order to clarify the true renal damage directly related to CM, we ask for prospective studies differentiating cohorts receiving intravenous and intra-arterial, transradial and transfemoral injections, and clinically relevant renal outcomes, thus avoiding the dangers that can come from the idolatry of a surrogate end point such an asymptomatic 25% transient increase of serum creatinine. To avoid that, patients may lose the possibility of a more useful radiological diagnosis, because of an exaggerated suspicion of risk.

show abstract

Atheroembolic renal disease with rapid progression and fatal outcome

Cited by 4 publications

References 25 publications

Cholesterol Crystal Embolism and Chronic Kidney Disease

Cholesterol Crystal Embolism and Chronic Kidney Disease

Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population

Pitfall in nephrology: contrast nephropathy has to be differentiated from renal damage due to atheroembolic disease

Contact Info

Product

Resources

About