Supportive treatment improves survival in multivisceral cholesterol crystal embolism

Belenfant, Xavier; Meyrier, Alain; Jacquot, C.

doi:10.1016/s0272-6386(99)70415-4

Cited by 213 publications

(258 citation statements)

References 22 publications

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“…In the last decade, some clinical studies have increased our understanding of AERD, enabling us to make premortem diagnosis. The presence of a triad characterized by a precipitating event, subacute renal failure, and peripheral cholesterol embolization strongly suggests the diagnosis, which can be confirmed by the biopsy of the target organs (1)(2)(3)(4)(5)(6).…”

mentioning

confidence: 98%

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Scolari¹,

Ravani

Pola³

et al. 2003

Journal of the American Society of Nephrology

124

150

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Abstract. Atheroembolic renal disease (AERD) is part of a multisystemic disease accompanied by high cardiovascular comorbidity and mortality. Interrelationships between traditional risk factors for atherosclerosis, vascular comorbidities, precipitating factors, and markers of clinical severity of the disease in determining outcome remain poorly understood. Patients with AERD presenting to a single center between 1996 and 2002 were followed-up with prospective collection of clinical and biochemical data. The major outcomes included end-stage renal disease (ESRD) and death. Ninety-five patients were identified (81 male). AERD was iatrogenic in 87%. Mean age was 71.4 yr. Twenty-three patients (24%) developed ESRD; 36 patients (37.9%) died. Cox regression analysis showed that significant independent predictors of ESRD were long-standing hypertension (hazard ratio [HR] ϭ 1.1; P Ͻ 0.001) and preexisting chronic renal impairment (HR ϭ 2.12; P ϭ 0.02); use of statins was independently associated with decreased risk of ESRD (HR ϭ 0.02; P ϭ 0.003). Age (HR ϭ 1.09; P ϭ 0.009), diabetes (HR ϭ 2.55; P ϭ 0.034), and ESRD (HR ϭ 2.21; P ϭ 0.029) were independent risk factors for patient mortality; male gender was independently associated with decreased risk of death (HR ϭ 0.27; P ϭ 0.007). Cardiovascular comorbidities, precipitating factors, and clinical severity of AERD had no prognostic impact on renal and patient survival. It is concluded that AERD has a strong clinical impact on patient and renal survival. The study clearly shows the importance of preexisting chronic renal impairment in determining both renal and patient outcome, this latter being mediated by the development of ESRD. The protective effect of statins on the development of ESRD should be evaluated in a prospective study.AERD is part of a multisystemic disease caused by showers of cholesterol emboli from atherosclerotic aorta to many organs. It may occur spontaneously or more often as a complication of major medical or surgical procedures. The disease is usually associated with poor renal and patient survival. In the last decade, some clinical studies have increased our understanding of AERD, enabling us to make premortem diagnosis. The presence of a triad characterized by a precipitating event, subacute renal failure, and peripheral cholesterol embolization strongly suggests the diagnosis, which can be confirmed by the biopsy of the target organs (1-6).Although the clinical features of the AERD have been well delineated, the predictors of the outcomes of the disease have never been studied in a large population of patients. In addition to the traditional risk factors for atherosclerosis, other factors may be associated with the outcomes, including comorbidities, precipitating factors, and clinical severity of the disease. However, the different and relative contribution of each factor is unknown. In the present study, we prospectively followed up 95 consecutive patients with diagnosis of AERD to gain insight into the interrelationship of potential predictors ...

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mentioning

confidence: 98%

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Scolari¹,

Ravani

Pola³

et al. 2003

Journal of the American Society of Nephrology

124

150

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“…Vascular procedures should generally be avoided. The recommended approach consists of treatment and prevention of cardiac failure and aggressive treatment of metabolic disorders using angiotensin converting enzyme inhibitors, loop diuretics, statins and haemodialysis [3,4]. Pentoxifylline has been reported anecdotally to be beneficial.…”

Section: Discussionmentioning

confidence: 99%

A 60-year-old Man With Bilateral Painful Reticular Patches Of Violaceous Color On The Soles

Tekin¹,

Saricam²,

Özgen³

et al. 2013

MMJ

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A 60-year-old male patient was referred for the evaluation of skin lesions on his soles which started as violaceous macules on tips of his toes three weeks before admission. Later, the lesions slowly progressed proximally to involve most of his soles in a mottled pattern and became painful. Physical examination revealed bilateral tender dark violaceous patches of reticular configuration on the soles, more prominent on the plantar surfaces of the distal phalanges of the right foot ( Figure 1). The reticular patches partly extended to the dorsal parts of the feet. A darker macule with a 0,5x1 cm sized eroded and necrotic area was seen on the plantar surface of the fifth digit of the right foot (Figure 2). Both feet were exquisitely tender to palpation. Dorsal pedal pulses were palpable bilaterally. Routine laboratory analysis revealed elevated blood urea nitrogen (61 mg/dl; normal range: 5-25 mg/dl), serum creatinine (4,33 mg/dl; normal range: 0,5 -1,10 mg/dl) and C-reactive protein levels (7,5 mg/dl normal range: 0-5 mg/dl). The patient had a 6-year history of hypertension and a 4-year history of diabetes mellitus which had been managed with antihypertensives and oral antidiabetics, respectively. His medical history was also remarkable for a coronary artery bypass graft (25 years ago), a transient left upper extremity weakness (2 years ago) and right carotid artery stent (7 months ago). Three months ago, he was admitted by the Neurology Department for acute-onset paraplegia and slurred speech and was diagnosed as a cerebrovascular accident. During his hospitalization in neurology, a nephrology consultation was obtained due to persistently elevated serum creatinine levels (2,10 to 2,69 mg/dl; normal range: 0,5 -1,10 mg/dl) and the patient

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“…Measures such as controlling the blood pressure and inhibiting the renin agiotensin system with angiotensin converting enzyme inhibitors or angiotensin receptor blockers are often indicated. The use of statins and antiplatelet agents may be beneficial [11,15,16], although controlled data is lacking. If possible, discontinuation of the anticoagulation is recommended [17].…”

Section: Discussionmentioning

confidence: 99%

Atheroembolic Renal Disease and Anticoagulants use: A Case Report and Literature Review

Pasupala

2012

World J Nephrol Urol

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Warfarin therapy is associated with improved clinical outcomes in several conditions including atrial fibrillation and thromboembolic disease. However, it can cause peripheral embolization by destabilizing the atherosclerotic plaque. This usually manifests as purple or blue toe syndrome, but isolated cases of renal manifestations are also reported. We report the case of a 77-year-old man who has been hemodialysis dependent due to warfarin induced atheroembolic renal disease. This is the most common cause of death in patients with cholesterol crystal embolization. Better understanding of the clinicopathological manifestations and high index of suspicion for the condition in predisposed patients can facilitate early diagnosis and potentially decrease the mortality risk.

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Supportive treatment improves survival in multivisceral cholesterol crystal embolism

Cited by 213 publications

References 22 publications

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

A 60-year-old Man With Bilateral Painful Reticular Patches Of Violaceous Color On The Soles

Atheroembolic Renal Disease and Anticoagulants use: A Case Report and Literature Review

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