Renal Cholesterol Microembolism: Is Steroid Therapy Effective?

Stabellini, N; Rizzioli, Emanuela; Trapassi, Maria Rita; Fabbian, Fabio; Catalano, Carlo; Gilli, P

doi:10.1159/000045769

Cited by 12 publications

(8 citation statements)

References 10 publications

(9 reference statements)

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“…31,73,75,[92][93][94] Improved renal function after steroid therapy and worsening of renal function after steroid withdrawal has also been argued. 95,96 According to the theory proposed by Jones and Iannaccone, 78 the CCE-induced vascular changes occur in 3 phases: (1) an early phase consisting of fresh crystal emboli causing endothelial injury and early histiocytic response, (2) an intermediate phase characterized by a giant cell reaction and intimal proliferation, and (3) a late phase in which the crystals are entrapped by histiocytes and additional intimal proliferation and fibrous tissue formation occur. 78 Based on this theory, steroids may attenuate the CCE-induced clinical picture by inhibiting the inflammatory response in the first 2 phases of the disease.…”

Section: Management Of Ccementioning

confidence: 99%

Cholesterol Crystal Embolization:A Possible Complication of Peripheral Endovascular Interventions

Paraskevas

Koutsias

Mikhailidis

et al. 2008

Journal of Endovascular Therapy

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Cholesterol crystal embolization (CCE) is a possible complication of peripheral endovascular interventions. The diagnosis of CCE is suggested by the gradual onset of peripheral cutaneous manifestations (e.g., livedo reticularis, blue toe syndrome) accompanied by progressive increases in blood urea nitrogen and creatinine levels following an invasive arterial procedure. On occasion, it may present with non-specific clinical signs and symptoms, which contributes to underdiagnosis. CCE is associated with significant morbidity and mortality. Prompt recognition of the presenting signs and symptoms, as well as a combination of treatment modalities is essential to reduce the risk of morbidity and mortality. CCE should always be part of the differential diagnosis in patients with progressively deteriorating renal function following a peripheral endovascular intervention. After the presentation of CCE, avoidance of anticoagulation and further invasive vascular procedures (e.g., angiography), along with symptomatic and supportive therapeutic measures, may help to achieve a better outcome.

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Section: Management Of Ccementioning

confidence: 99%

Cholesterol Crystal Embolization:A Possible Complication of Peripheral Endovascular Interventions

Paraskevas

Koutsias

Mikhailidis

et al. 2008

Journal of Endovascular Therapy

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“…These latter reports correspond to cases of either massive cholesterol crystal embolization, with treatment given late in the course of the disease or given for a short period. In our patient, prednisolone dose was intermediate -between the 0.3 mg/kg per day reported in Belenfant et al [8] and the higher doses used in other reports [11,27]. It was introduced 3 days after the diagnosis and maintained until treatment failure was evident.…”

Section: Discussionmentioning

confidence: 63%

Atheroembolic renal disease with rapid progression and fatal outcome

et al. 2010

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Atheroembolic renal disease is caused by foreign-body reaction to cholesterol crystals flushed from the atherosclerotic plaques into the small-vessel system of the kidneys. It is an underdiagnosed entity, mostly related to vascular procedures and/or anticoagulation, and prognosis is considered to be poor. Besides the benefit of aggressive medical prevention of further embolic events, use of steroid therapy has been associated with greater survival. Here we report a case of a patient with a multisystemic presentation of the disease days after performance of percutaneous coronary intervention and anticoagulation initiation due to an episode of myocardial infarction. Renal, cutaneous, ophthalmic, neurological, and possibly muscular and mesenteric involvement was diagnosed. Although medical treatment with corticosteroids and avoidance of further anticoagulation was applied, the patient rapidly progressed to end-stage renal disease requiring hemodialysis and died 6 months after diagnosis. This is a case of catastrophic progression of the disease resistant to therapeutic measures. Focus on diagnosis and more efficient preventive and therapeutic protocols are therefore needed.

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“…A case reported by Stabellini et al showed some improvement in renal function with steroid use but also highlighted the potential for adverse reactions to steroid therapy since most cases of cholesterol embolism occur in the elderly 14. Corticosteroids are used with the primary intention of reducing the inflammatory response associated with atheroembolism and some studies have shown improvement in renal outcomes in CCE patients 15.…”

Section: Discussionmentioning

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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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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Renal Cholesterol Microembolism: Is Steroid Therapy Effective?

Cited by 12 publications

References 10 publications

Cholesterol Crystal Embolization:A Possible Complication of Peripheral Endovascular Interventions

Cholesterol Crystal Embolization:A Possible Complication of Peripheral Endovascular Interventions

Atheroembolic renal disease with rapid progression and fatal outcome

Renal cholesterol crystal embolism in the setting of warfarin use

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