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.
NDT Plus 01/2010; 3(2):162-164. DOI:10.1093/ndtplus/sfp163
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ABSTRACT: Cannulation of the abdominal aorta in older donors with advanced atherosclerotic disease is challenging and may lead to dissection or plaque embolization. We describe a different technique, short segment aortic endarterectomy, which can be a useful alternative during organ procurement. It permits safer cannulation and securing of atherosclerotic infrarenal aortas, thereby allowing us to flush and safely use organs that otherwise would have been discarded.Clinical Transplantation 03/2011; 25(2):E219-22. DOI:10.1111/j.1399-0012.2010.01394.x · 1.49 Impact Factor
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 · 39.21 Impact Factor