Atheroembolic renal disease

Summary 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 usual...

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Bibliographic Details
Published in:The Lancet (British edition) 2010-05, Vol.375 (9726), p.1650-1660
Main Authors: Scolari, Francesco, Dr, Ravani, Pietro, MD
Format: Article
Language:English
Subjects:
Anticoagulants
Aortic Diseases - complications
Atherosclerosis
Atherosclerosis - complications
Biological and medical sciences
Blood clots
Cholesterol
Clinical medicine
Clinical trials
Coronary Angiography - adverse effects
Crystals
Embolism, Cholesterol - diagnosis
Embolism, Cholesterol - etiology
Embolism, Cholesterol - physiopathology
Embolism, Cholesterol - therapy
General aspects
Humans
Hypertension
Internal Medicine
Medical imaging
Medical sciences
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Renal failure
Renal Insufficiency - diagnosis
Renal Insufficiency - etiology
Risk Factors
Statins
Studies
Veins & arteries
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Summary:Summary 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.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(09)62073-0