Cholesterol Crystal Embolism and Chronic Kidney Disease

Li, Xuezhu; Bayliss, George; Zhuang, Songlin

doi:10.3390/ijms18061120

Cited by 41 publications

(39 citation statements)

References 58 publications

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“…The mainstay of management of CCE includes minimising risk factors and providing supportive care in the case of worsening renal failure. Statins may have a beneficial effect by contributing to plaque stabilisation and regression through their lipid-lowering and anti-inflammatory properties3 13 but the role of steroids is limited 13…”

Section: Discussionmentioning

confidence: 99%

“…The underlying pathophysiology includes plaque haemorrhage or rupture as a precipitating event or plaque destabilisation in the setting of anticoagulation use, leading to atheroembolism 2. Other pathways including the activation of renin–angiotensin–aldosterone system, complement activation and direct tissue injury causing necroinflammation3 play a direct role as well, though exact mechanism is still not entirely known. The presenting symptoms of CCE depend on location and extent of embolisation.…”

Section: Introductionmentioning

confidence: 99%

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Renal cholesterol crystal embolism in the setting of warfarin use

Munawar

Ibe

Jiwa³

et al. 2019

BMJ Case Rep

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A 73-year-old man presented for evaluation of weakness and black tarry stools that occurred 1 day prior to admission. His medical history is significant for diabetes mellitus, stage 3 chronic kidney disease and deep vein thrombosis on warfarin. He was admitted to the hospital and was found to have acute kidney injury and gastrointestinal bleeding due to a supratherapeutic International Normalized Ratio. His hospital course was complicated by persistent decline in his renal function. He was given intravenous fluid resuscitation, fresh frozen plasma and packed red blood cells for his acute blood loss anaemia. Urinalysis was consistent with acute tubular necrosis. Given the persistent rise in creatinine, a kidney biopsy was obtained, and was significant for mild inflammatory changes, without evidence of vasculitis or allergic interstitial nephritis. Histopathological examination with tissue fixation revealed cholesterol embolisation. Given that he had no recent endovascular procedure or instrumentation, this atheroembolic event was attributed to his warfarin use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Renal cholesterol crystal embolism in the setting of warfarin use

Munawar

Ibe

Jiwa³

et al. 2019

BMJ Case Rep

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“…In clinical aspects, Chcs embolization is one of the most important diseases associated with Chcs. A biopsy of the kidney or other tissue is used to find Chcs in the tissue to diagnose Chcs emboli [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

High-Contrast Imaging of Cholesterol Crystals in Rabbit Arteries Ex Vivo Using LED-Based Polarization Microscopy

Cho

Kim

et al. 2018

Sensors

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Detection of cholesterol crystals (Chcs) in atherosclerosis disease is important for understanding the pathophysiology of atherosclerosis. Polarization microscopy (PM) has been in use traditionally for detecting Chcs, but they have difficulty in distinguishing Chcs with other crystalline materials in tissue, such as collagens. Thus, most studies using PM have been limited to studying cell-level samples. Although various methods have been proposed to detect Chcs with high specificity, most of them have low signal-to-noise ratios, a high system construction cost, and are difficult to operate due to a complex protocol. To address these problems, we have developed a simple and inexpensive universal serial bus (USB) PM system equipped with a 5700 K cool-white light-emitting diode (LED). In this system, Chcs are shown in a light blue color while collagen is shown in a yellow color. More importantly, the contrast between Chcs and collagens is improved by a factor of 2.3 under an aqueous condition in these PM images. These imaging results are well-matched with the ones acquired with two-photon microscopy (TPM). The system can visualize the features of atherosclerosis that cannot be visualized by the conventional hematoxylin and eosin and oil-red-o staining methods. Thus, we believe that this simple USB PM system can be widely used to identify Chcs in atherosclerosis.

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“…Histopatolojik değerlendirmede kolesterol kristalleri doku hazırlığı işleminde çözündüğünden boş, bikonveks, iğne şeklinde kleftler görülür. Etkilenen arteriollerin transvers kesitinde intimal kalınlaşma, yabancı cisim dev hücreleri, trombüs ve fibrin ile çevrelenmiş iğne şeklinde kleftler izlenir (12). Ancak mikroembolilerin düzensiz ve yamasal dağılımı nedeniyle kolesterol kleftlerini göstermek sıklıkla güç olmaktadır.…”

Section: Kaynaklarunclassified

Cholesterol emboli syndrome after angiography: a report of two cases

Uzun¹,

Leblebıcı²,

Aksu³

2019

JCurrPath

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ÖZET Amaç: Kolesterol emboli sendromu aterosklerotik plaklardan kopan kolesterol kristallerinin küçük çaplı arter ve arteriolleri tıkaması ile oluşan yaygın aterosklerozun bir komplikasyonudur. Bu olgu sunumunun amacı koroner anjiografi sonrası gelişen livedo retikülaris ve purpura gibi deri bulgularının varlığında kolesterol embolisinden şüphelenilmesi ve patolojik incelemede kolesterol kleftlerinin görülebilmesi için blokların tamamının seri kesitlerle incelenmesi gerektiğine dikkat çekmektir.Olgu: Alt ekstremitede kızarıklık ve ağrı şikayeti ile dermatoloji polikliniğine başvuran iki erkek hastanın dermatolojik muayenesinde alt ekstremitede retiküler purpurik yamalar izlendi. Her iki hastada da yakın zamanda yapılmış koroner anjiografi öyküsü mevcuttu. Kolesterol embolisi ön tanısı ile gönderilen punch biyopsi örnekleri seri kesitler alınarak incelendi. Histopatolojik incelemelerinde kolesterol kleftleri saptanarak kolesterol emboli tanısı konuldu. Kutanöz tutulum dışında ek organ tutulumu saptanmadı.Sonuç: Klinik bulguların ayırdedici olmaması ve kesin tanı için histopatolojik inceleme gerekliliği nedeniyle kolesterol embolisi tanısı sıklıkla atlanmaktadır. Anjiografi uygulandıktan sonra livedo retikülaris, purpura gibi deri lezyonları gelişen hastalarda kolesterol embolisi ayırıcı tanıda düşünülmeli ve doğru tanı için alınan doku örneğinin tamamı seri kesitler yapılarak incelenmelidir. ABSTRACTAim: Cholesterol embolization syndrome is a complication of widespread atherosclerosis in which cholesterol crystals break off from atherosclerotic plaques and occlude small arteries and arterioles. The aim of this report is to draw attention to consider cholesterol embolism in differential diagnosis of patients who present with skin lesion such as livedo reticularis and purpura after coronary angiography, and to necessity to examine all specimens by serial sectioning to identify cholesterol clefts in pathological examination.Case: Two male patients that visited the dermatology outpatient clinic with complaints of redness and pain in their lower extremities presented with reticular purpuric patches on dermatological examination. Both patients reported history of recent coronary angiography. Preliminary diagnosis of cholesterol embolism was made, and punch biopsy samples were examined by serial sectioning. Cholesterol clefts were identified by histopathological examination of the specimens, and diagnosis of cholesterol embolism was made. No additional organ involvement other than cutaneous involvement was detected. Conclusion:The lack of distinctive clinical findings and the need for histopathological examination for definitive diagnosis often lead to underdiagnosis of cholesterol embolism. Cholesterol embolism must be considered in the differential diagnosis of the patients who present with skin lesions like livedo reticularis and purpura after angiography. All tissue samples should be examined by serial sectioning for accurate diagnosis. İlk olgu 25.05.2017 tarihinde Taksim Point Otelde düzenlenen Deri ve Zührevi Hast...

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Cholesterol Crystal Embolism and Chronic Kidney Disease

Cited by 41 publications

References 58 publications

Renal cholesterol crystal embolism in the setting of warfarin use

Renal cholesterol crystal embolism in the setting of warfarin use

High-Contrast Imaging of Cholesterol Crystals in Rabbit Arteries Ex Vivo Using LED-Based Polarization Microscopy

Cholesterol emboli syndrome after angiography: a report of two cases

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