Renal failure and acute pancreatitis developed in a 63-year-old man after 2 angiography procedures and iliac artery surgery. The results of the renal biopsy showed no specific abnormalities and the cause of the pancreatitis could not be determined. The patient was treated with hemodialysis and conservative management for pancreatitis, however he died due to sepsis approximately 50 days after diagnosis. The autopsy revealed cholesterol crystals in several organs including the kidneys, pancreas, and spleen. Therefore, systemic cholesterol emboli may have contributed to the development of renal failure and acute pancreatitis in this case. Cholesterol crystals in the pancreas have frequently been observed at autopsy in patients with cholesterol emboli. The clinical development of acute pancreatitis, however, is quite rare in these cases. The present case is reported to increase awareness of the possible clinical presentations of systemic cholesterol embolic disease in an effort to increase the correct diagnosis of this condition.Clin Exper Nephrol 1997;1:136-141Key words: cholesterol embolism, acute renal failure, acute pancreatitisCholesterol embolic disease (CED) is a multisystem disorder caused by cholesterol crystal emboli in various organsJ -7 CED occurs predominantly in elderly men with atherosclerotic cardiovascular disease, and after angiographic procedures, vascular surgery, or anticoagulant therapy. The most common clinical presentations of CED are acute renal failure and cutaneous manifestations. It is usually difficult to diagnose premortem, and the mortality rate is high. Autopsies reveal cholesterol emboli in multiple organs including the pancreas, however, the clinical development of acute pancreatitis is extremely rare in CED. We describe a case of CED presenting as renal failure with acute pancreatitis, which was diagnosed histologically after the patient's death.
CASE REPORTA 63-year-old man with a 14-year history ofhypertension was admitted for treatment of arteriosclerosis obliterans (ASO) in August 1995. He had intermittentReceived Sep. 12, 1996; revised Jan. 20, 1997; accepted for publication in revised form Feb. 27, 1997. *Correspondence and requests for reprints to: Department of Nephrology, Tokyo Medical College, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160, Japan.claudication 3 years before admission, and smoked a pack of cigarettes daily for 40 years. He previously drank alcohol regularly for many years, but had not drunk excessively in recent years. On admission, his serum creatinine level was 0.9 mg/dL and his 24-hour creatinine clearance was 83.5 mL/min, with no abnormalities in urine sediment. His blood pressure was maintained within normal limits (systolic/diastolic, 120 to 140/70 to 80 mm Hg), by administration of 2 antihypertensive drugs. Aortography and coronary angiography showed stenosis of both external and internal iliac arteries on both sides, and the right coronary artery, respectively. Neither renal artery had extensive stenosis. To treat the right external iliac artery stenos...