atheroembolic renal failure

Etiology

• idiopathic (spontaneous)
  • atherosclerosis
• after an invasive procedure
  • angiography
  • angioplasty
  • vascular surgery
  • intra-aortic balloon pump
• anticoagulation
• thrombolysis

Epidemiology

• older patients
• often a history of smoking

Pathology

• cholesterol emboli in distal small & medium-sized arteries
  • biconcave crystalline clefts
• intense tubulointerstitial nephritis

Clinical manifestations

• livedo reticularis of the extremities
• emboli seen on funduscopic examination
  • Hollenhorst bodies
• other organ system dysfunction may occur concurrently
  • cerebral ischemia
  • intestinal vascular insufficiency
• ARF after 24 hr (slower onset than ARF secondary to radiographic contrast media)

Laboratory

• rule/out alternative diagnosis
  • high erythrocyte sedimentation rate (ESR)
  • CH50: low level of complement
  • complete blood count (CBC)
    • leukocytosis
    • eosinophilia
    • thrombocytopenia
  • eosinophils in the urine -> AIN
• biopsy of muscle, skin or kidney (see cholesterol embolism)

Differential diagnosis

• vasculitis
• glomerulonephritis
• acute interstitial nephritis (AIN)
• acute tubular necrosis
• contrast-induced nephropathy

Management

• correct the source of embolization
  • atrial fibrillation
  • cardiac valvular disease
  • endocarditis
• anticoagulation may aggravate the tendency for embolization
• treatment of hypertension
• dialysis may be necessary
• prognosis: generally minimally reversible renal failure

More general terms

• renal failure; kidney failure
• atheroembolism; cholesterol embolism; aortic atheroembolism