Cholesterol Crystal Embolism Syndrome in Dialysis Patients: An Emerging Clinical Diagnosis?

Abstract

Background: Cholesterol crystal embolism syndrome (CCE) is an increasing end-stage renal disease cause. Few cases have been described on dialysis, despite the high prevalence of the predisposing factors. Methods: The diagnostic criteria of the present study were: skin lesions, myalgia, fatigue, fever and acute inflammatory serologic signs, in the presence of severe vasculopathy. The precipitating factors were: anticoagulation, endovascular intervention and ulcerated atherosclerotic plaque. Results: Between October 2003 and September 2005, CCE was diagnosed in 6 dialysis patients (of 200–210 on chronic treatment): 5 males, 1 female, median age 59.5 years (47–70) and end-stage renal disease follow-up 11.5 years (3–25). All had severe vasculopathy, 5 cardiopathy, and 4 were failed graft recipients. The treatment included: peritoneal dialysis, daily dialysis, ‘conventional’ hemodialysis (2 cases) and hemodiafiltration. The diagnosis was based on the clinical-laboratory picture in 1 patient. In the 5 others clues were present (dicumarol therapy, angioplasty, femoral artery thrombosis, CCE predialysis and ulcerated aortic plaque). The therapeutic approach consisted of corticosteroids (5 cases), statins (4 cases) and prostaglandin analogues (4 cases). Conclusion: The differential diagnosis of CCE should also be considered in dialysis patients (necrotic lesions, limb pain and vasculitis-like signs).

Cholesterol microcrystals and cochleate cylinders: Attachment of pyolysin oligomers and domain 4

“…PerlTreves et al, 1996). However, there is some medical emphasis on cholesterol crystal embolism (Piccoli et al, 2006), the differing cholesterol crystal states detectable during gall stone formation (Konikoff et al, 1992;Chung et al, 1993;Solomonov et al, 2005) and macrophage foam cell cholesterol crystals in relation to atherosclerotic plaque formation (Klinkner et al, 1995;Kellner-Weibel et al, 1999). Cholesterol has been the subject of structural study for some time; the crystal structure of cholesterol monohydrate was determined by Craven (1976) and the complex phase behaviour of cholesterol monohydrate was investigated by Loomis et al (1979) and Hsu and Nordman (1983).…”

Blue Toe Syndrome after the Discontinuation of Statin Therapy in a Patient on Chronic Hemodialysis

“…An extensive PubMed search, involving the combination of key synonyms for cholesterol embolization syndrome and dialysis, yielded only five reports on cholesterol emboli in chronic dialysis patients. [3][4][5][6][7] This could be attributed to the greater diagnostic challenges in patients on chronic dialysis because embolization of one of the main target organs (i.e. the kidneys) is no longer detectable.…”

Cholesterol Embolization Syndrome Developing after Coronary Angiography in a Hemodialysis Patient

“…The primary manifestation of renal CES is an increase in serum creatinine, proteinuria and HT and may lead to acute or chronic kidney failure (11,12). Despite the high frequency of precipitating factors (diffuse cardiovascular disease, hypertension, dyslipidemia, diabetes), very few CES cases are reported in dialysis patients in the literature (13). Unfortunately, the diagnosis is generally missed in dialysis patients due to the fact that there is no diagnostic serological method and the disorder may not be considered in the differential diagnosis.…”