Cholesterol embolization in a renal graft
ABSTRACT Cholesterol embolization into native kidneys has a dim prognosis for renal function and frequently leads to irreversible renal failure. Although uncommon, cholesterol embolization may also occur in renal allografts, particularly if either the recipient or the donor has prominent atherosclerosis. We report here on a case of a 65-yr-old man with cholesterol emboli in the renal allograft and delayed graft function. The recipient's arteria iliaca externa was a potential source because of heavy atherosclerosis. The patient was dialysis-dependent for two wk after transplantation. However, renal function improved, no cholesterol emboli were found in a second biopsy of the graft and serum creatinine is 260 micromol/L six months after the transplantation. In the case of primary renal non-function or dysfunction, cholesterol embolization must be considered in the differential diagnosis. If renal cholesterol embolization originates from the recipient, allograft survival is usually good. In contrast, if cholesterol embolization is of donor origin, graft dysfunction and subsequent graft loss are common. The reason for this difference may be the more extensive embolization developing in an atherosclerotic cadaver donor occurring during the organ procurement or the severe trauma leading to death.
- SourceAvailable from: Francesco Scolari
Article: [Atheroembolic renal disease].[Show abstract] [Hide abstract]
ABSTRACT: Atheroembolic renal disease can be defined as renal failure due to occlusion of the renal arterioles by cholesterol crystal emboli usually dislodged from ulcerated atherosclerotic plaques of the aorta. Atheroembolic renal disease is part of multisystem disease, since the embolization usually involves other organ systems such as the gastrointestinal system, central nervous system, and lower extremities. The kidney is frequently involved because of the proximity of the renal arteries to the abdominal aorta, where erosion of atheromatous plaques is most likely to occur. Embolization may occur spontaneously or after angiographic procedures, vascular surgery, and anticoagulation. In the last decade, atheroembolic renal disease has become a recognizable cause of renal disease. An ante-mortem diagnosis of the disease is possible in a significant proportion of cases as long as the level of diagnostic suspicion is high. The disease can severely affect kidney and patient survival. Although no specific treatment has been proven efficacious, use of statins may be justifiable and such therapy would be a reasonable choice for future treatment trials.Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 26(2):181-90.
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ABSTRACT: Cholesterol embolization (CE) is a well-known cause of renal dysfunction, often leading to irreversible renal failure most often in elderly patients. However, because of its unspecific and subclinical appearance, CE is often misdiagnosed. As donors and recipients of increasing age or with prominent atherosclerotic disease are accepted for transplantation, CE in renal allografts may become more prevalent. Here, we report a case of a 31-year-old second renal allograft recipient with CE as a cause of early graft failure, followed by severe vascular rejection, eventually requiring nephrectomy.NDT Plus 04/2010; 3(2):162-164. DOI:10.1093/ndtplus/sfp163
Article: Atheroembolic renal disease[Show abstract] [Hide abstract]
ABSTRACT: Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often affects other organs, such as the skin, gastrointestinal system, and brain. Although the disease can develop spontaneously, it usually develops after vascular surgery, catheterisation, or anticoagulation. The systemic nature of atheroembolism makes diagnosis difficult. The classic triad of a precipitating event, acute or subacute renal failure, and skin lesions, are strongly suggestive of the disorder. Eosinophilia further supports the diagnosis, usually confirmed by biopsy of an affected organ or by the fundoscopic finding of cholesterol crystals in the retinal circulation. Renal and patient prognosis are poor. Treatment is mostly preventive, based on avoidance of further precipitating factors, and symptomatic, aimed to the optimum treatment of hypertension and cardiac and renal failure. Statins, which stabilise atherosclerotic plaques, should be offered to all patients. Steroids might have a role in acute or subacute progressive forms with systemic inflammation.The Lancet 04/2010; 375(9726):1650-60. DOI:10.1016/S0140-6736(09)62073-0 · 45.22 Impact Factor