Eosinophilia in the Diagnosis of Atheroembolic Renal Disease

Kasinath, Balakuntalam S.; Corwin, Howard L.; Bidani, A.; Korbet, Stephen M.; Schwartz, Melvin M.; Lewis, Edmund J.

doi:10.1159/000167459

Cited by 87 publications

(42 citation statements)

References 9 publications

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“…The prevalence of eosinophilia found in our study is slightly higher than observed previously [15, 24]; it was measured systematically in our patients and we question if it was so in other reports. Therefore, it is interesting to note that eosinophilia was present more than 1 month after the diagnosis was made.…”

Section: Discussioncontrasting

confidence: 84%

Atheroembolic Renal Failure Requiring Dialysis: Potential for Renal Recovery?

et al. 2004

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Aims: Our objectives were to review the characteristics of patients who developed atheroembolic renal disease requiring dialysis as well as their renal function recovery and survival rates. Methods: All cases of atheroembolic disease with renal failure severe enough to require dialysis were reviewed from January 1984 to December 2000 in two centers. The diagnosis of atheroemboli was based on clinical presentation and/or biopsy. Acute renal failure was defined as a serum creatinine >200 µmol/l if normal at baseline or doubling from baseline if chronic renal failure, whereas renal function recovery was the ability to discontinue renal replacement therapy for ≧3 months. Results: Forty-three cases were identified (37 males and 6 females; mean age 67 ± 5 years); the average time to acute renal failure and to diagnosis was similar at 36 days. The majority of patients had at least one precipitating factor identified (58% coronary angiography, 26% angiography, 16% vascular surgery, 2% anticoagulation); 1 had a spontaneous presentation whereas 7 had more than one factor. More than 90% had underlying hypertension and chronic renal dysfunction with a baseline creatinine of 195 ± 81 µmol/l, approximately 80% had coronary artery disease, 80% were smokers, 60% had a history of abdominal aorta aneurysm, >50% presented with intermittent claudication, and 56% were anticoagulated at the time of the event. Most patients were nonoliguric (80%), had increased hypertension (71%), blue toes (67%), livedo reticularis (52%), whereas abdominal pain and central nervous system symptoms were present in 33 and 7% of the cases, respectively. Eosinophilia was found in 88%, while hypocomplementemia was present in less than 15%. When compared to the 12 patients with recovery of renal function (after a mean delay of 409 ± 336 days), the 31 patients who did not recover function presented with more severe intermittent claudication and underlying chronic renal dysfunction (p < 0.05). Indeed, the only variable found to unfavorably influence renal function recovery was the presence of intermittent claudication. Patients were mainly treated by intermittent hemodialysis except for 5 (2 on CRRT and 3 on peritoneal dialysis). Renal function recovery was associated with a higher chance of survival; 33% of patients died in the first year after diagnosis. Conclusion: Atheroembolic renal disease carries a high mortality rate reflective of the extensive cardiovascular disease of affected patients; nevertheless, the potential for renal function recovery appears greater than for other vascular causes of renal failure.

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Section: Discussioncontrasting

confidence: 84%

Atheroembolic Renal Failure Requiring Dialysis: Potential for Renal Recovery?

et al. 2004

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“…Eosinophilia is an abnormal laboratory fi nding that frequently occurs during the acute phase of the disease, thereby showing immunological activation at the surface of the exposed emboli. [8][9][10][11][12] In a previous review, Kasinath and co-workers 70 described eosinophilia in 80% of cases of atheroembolic renal disease. Eosinophilia was typically transient, ranging from 6% to 18% in a recent study.…”

Section: Laboratory Fi Ndingsmentioning

confidence: 99%

Atheroembolic renal disease

2010

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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.

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“…From a review of the literature, Kasinath et al 57 found an 80% incidence of eosinophilia when adequate white blood cell counts and differentials were reported. Subsequent reports found an incidence of eosinophilia varying from 14% to 71%.…”

Section: Laboratory Featuresmentioning

confidence: 99%

“…The presence of other complications of atheroembolism, such as gastrointestinal bleeding and neurological involvement, should raise the level of suspicion. Among the laboratory features, helpful clues to the diagnosis include the presence of eosinophilia 57 and an increase in the markers of acute inflammation, in association with ANCA negativity. [1][2][3]12 Histological confirmation has traditionally been considered essential to the antemortem diagnosis of atheroembolic renal disease.…”

Section: Diagnosismentioning

confidence: 99%

Cholesterol crystal embolism: A recognizable cause of renal disease

Scolari

Tardanico

Zani

et al. 2000

American Journal of Kidney Diseases

244

256

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• Cholesterol crystal embolism, sometimes separately designated atheroembolism, is an increasing and still underdiagnosed cause of renal dysfunction antemortem in elderly patients. Renal cholesterol crystal embolization, also known as atheroembolic renal disease, is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small renal arteries. Although cholesterol crystal embolization can occur spontaneously, it is increasingly recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism may give rise to different degrees of renal impairment. Some patients show only a moderate loss of renal function; in others, severe renal failure requiring dialysis ensues. An acute scenario with abrupt and sudden onset of renal failure may be observed. More frequently, a progressive loss of renal function occurs over weeks. A third clinical form of renal atheroemboli has been described, presenting as chronic, stable, and asymptomatic renal insufficiency. The renal outcome may be variable; some patients deteriorate or remain on dialysis, some improve, and some remain with chronic renal impairment. In addition to the kidneys, atheroembolization may involve the skin, gastrointestinal system, and central nervous system. Renal atheroembolic disease is a difficult and controversial diagnosis for the protean extrarenal manifestations of the disease. In the past, the diagnosis was often made postmortem. However, in the last decade, awareness of atheroembolic renal disease has improved, enabling us to make a correct premortem diagnosis in a number of patients. Correct diagnosis requires the clinician to be alert to the possibility. The typical patient is a white man aged older than 60 years with a baseline history of hypertension, smoking, and arterial disease. The presence of a classic triad characterized by a precipitating event, acute or subacute renal failure, and peripheral cholesterol crystal embolization strongly suggests the diagnosis. The confirmatory diagnosis can be made by means of biopsy of the target organs, including kidneys, skin, and the gastrointestinal system. Thus, Cinderella and her shoe now can be well matched during life. Patients with renal atheroemboli have a dismal outlook. A specific treatment is lacking. However, it is an important diagnosis to make because it may save the patient from inappropriate treatment. Finally, recent data suggest that an aggressive therapeutic approach with patient-tailored supportive measures may be associated with a favorable clinical outcome.

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Eosinophilia in the Diagnosis of Atheroembolic Renal Disease

Cited by 87 publications

References 9 publications

Atheroembolic Renal Failure Requiring Dialysis: Potential for Renal Recovery?

Atheroembolic Renal Failure Requiring Dialysis: Potential for Renal Recovery?

Atheroembolic renal disease

Cholesterol crystal embolism: A recognizable cause of renal disease

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