The Effect of Low-Dose Corticosteroids on Short- and Long-Term Renal Outcome in Patients with Cholesterol Crystal Embolism

Nakayama, Masaru; Izumaru, Kensuke; Nagata, Michio; Ikeda, Hirofumi; Nishida, Kanako; Hasegawa, Eri; Ohta, Yuko; Tsuchihashi, Takuya; Urabe, Kazunori

doi:10.3109/0886022x.2011.560403

Cited by 32 publications

(22 citation statements)

References 26 publications

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“…Although previous reports have suggested that steroid therapy lacks efficacy in long-term renal outcomes, in three of our cases, positive renal outcomes following CCE persisted not only in the shortterm, but also over the long-term (16). In fact, in Case 2, dialysis was no longer necessary only one month after corticosteroid administration due to sufficient recovery of the renal function, a recovery that continued long-term.…”

Section: Discussioncontrasting

confidence: 46%

“…Several reports have shown favorable effects of high-dose corticosteroid therapy on CCE-induced renal deterioration (19,20), although the use of high-dose corticosteroids increases the risk of cardiovascular side effects and opportunistic infections, especially in elderly and diabetic patients. Nakayama et al reported that low-dose corticosteroids (10-20 mg/day (0.3 mg/kg/day)) achieved favorable, short-term renal outcomes in CCE patients (16). In our cases, we initiated steroid therapy at a dose of 20 mg/day following CCE diagnosis.…”

Section: Discussionmentioning

confidence: 81%

“…Recently, corticosteroid therapy has been reported to be beneficial for CCE patients in reducing local and general inflammatory responses (12)(13)(14)(15). Nakayama et al reported that low-dose corticosteroids (10-20 mg/day (0.3 mg/kg/day)) achieved favorable, short-term renal outcomes in CCE patients (16).…”

Section: Discussionmentioning

confidence: 99%

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Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

et al. 2013

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Cholesterol crystal embolism (CCE) is a serious complication associated with invasive vascular procedures. The prognosis of the renal involvement type of CCE is very poor, and there is currently no established treatment, other than supportive therapy. We herein report four cases of CCE with severe atherosclerosis wherein the renal function progressively deteriorated after cardiac catheterization. In three of the four patients, lowdose corticosteroids (0.3 mg/kg/day) improved the renal function, whereas the fourth patient died from CCE of the digestive system. This report reviews the literature on CCE and discusses possible therapeutic options.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 81%

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Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

et al. 2013

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“…Although older reports have linked the use of steroid to poor prognosis [ 1 ] , the results of more recent studies with steroid therapy have suggested that low dose might be beneficial [ 48 ] . A recent retrospective study of steroid therapy in patients with renal CCE showed a good renal outcome at 4 weeks; however, this treatment did not have a favorable effect on long-term renal outcome [ 55 ] . …”

Section: Managementmentioning

confidence: 99%

Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features

et al. 2017

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Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.

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“…Kortikosteroide werden seit über 20 Jahren mit unterschiedlichem Erfolg bei der Cholesterinembolie eingesetzt. Die meisten Erfahrungen existieren für niedrige Dosierungen (10-20 mg Prednison pro Tag) [26,27], seltener wurden höhere Dosen (> 40 mg/Tag) bis hin zu Stoßtherapien (250 mg/Tag) [4, 33,34] angewendet. In einzelnen Fällen wurde bei Vaskulitis-ähnlichen Verläufen die Steroidgabe noch mit Cyclophosphamid kombiniert [39].…”

Section: Diagnose ▼unclassified

Cholesterinembolie-Syndrom: eine seltene, aber schwerwiegende Komplikation bei Atherosklerose

Frank

2012

Dtsch med Wochenschr

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Cholesterol embolization is a serious complication of atherosclerosis. Mainly, vascular manipulations during endovascular procedures or vascular surgery can release cholesterol crystals from atheromatous plaques. About 20 % are spontaneous emboli without precipitating event. The cholesterol crystals are distributed by the blood stream, occlude small arteries and induce inflammation. Typically, 2 to 6 weeks after a vascular procedure renal failure and characteristic cutaneous signs develop. Livedo reticularis and blue toes, although classic symptoms, are not pathognomonic and may be even absent. Vasculitis is an important differential diagnosis. Diagnosis can only be proven by skin, muscle or kidney biopsy. Alternatively, fundoscopy can show retinal cholesterol emboli. Therapy is mostly limited to symptomatic measures. Corticosteroids have no proven efficacy and may be harmful. Statins should be given to all patients due to their plaque stabilizing and anti-inflammatory properties. Randomized clinical trials are lacking in this field. Prognosis is limited. About 30-55 % patients with renal involvement need renal replacement therapy. Mortality is high with 15-30 % of patients dying during the first year.

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The Effect of Low-Dose Corticosteroids on Short- and Long-Term Renal Outcome in Patients with Cholesterol Crystal Embolism

Abstract: During the short period after CCE diagnosis, steroid therapy showed a good renal outcome in CCE patients. However, this treatment did not have a favorable effect on long-term renal outcome.

Cited by 32 publications

References 26 publications

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features

Cholesterinembolie-Syndrom: eine seltene, aber schwerwiegende Komplikation bei Atherosklerose

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