Renal Cholesterol Embolic Disease

Lye, Wai Choong; Cheah, J. S.; Sinniah, Raja

doi:10.1159/000168669

Cited by 111 publications

(36 citation statements)

References 20 publications

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“…The rate of renal functional recovery sufficient to discontinue dialysis was 27.9% in our study, similar to previously reported rates [15, 20, 23]. However, this was a partial recovery of renal function allowing patients to discontinue dialysis and not a return to baseline serum creatinine, suggesting irreversible parenchymal damage.…”

Section: Discussionsupporting

confidence: 89%

“…Although atheroembolic renal disease is relatively easy to recognize on clinical grounds, not much information has been published about the evolution of patients who suffer severe renal dysfunction requiring dialysis. Only a few studies have addressed the potential for renal functional recovery (reported as varying from 21 to 32%) [20, 23]. Our study attempted to better characterize the subgroup of patients with atheroembolic renal disease severe enough to require dialytic support and to possibly identify predictive factors for renal functional recovery and survival.…”

Section: Discussionmentioning

confidence: 99%

“…Belenfant et al [20]observed that 32% of cases recovered sufficiently to discontinue dialysis. In a literature review, Lye et al [23]found a 21% rate of renal function recovery allowing dialysis cessation.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Atheroembolic Renal Failure Requiring Dialysis: Potential for Renal Recovery?

et al. 2004

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“…The emboli of CCs generally are defined by the empty, biconvex, and needle-shaped clefts, appearing as “ghosts”, because CCs usually dissolve during routine histologic preparation procedures. However, in frozen sections, the crystals are birefringent under polarized light and give positive histochemical reactions for lipids [30]. Interlobular and arcuate arteries showed a perivascular polymorphonuclear and eosinophilic infiltration.…”

Section: Pathologymentioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

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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.

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“…Statins might stabilise plaques, and there are anecdotal reports of their efficacy,11 but no firm recommendation can be made. Steroid treatment has been reported to be of benefit by some, but others report no advantage or even increased mortality 12 – 15…”

Section: Discussionmentioning

confidence: 99%