Clinical and Experimental Nephrology

, Volume 15, Issue 1, pp 159–163 | Cite as

Atheroembolic renal disease with rapid progression and fatal outcome

  • Bernardo FariaEmail author
  • Joana Vidinha
  • Cátia Pêgo
  • Jesus Garrido
  • Sérgio Lemos
  • Carla Lima
  • Giovanni Sorbo
  • Edgar Lorga Gomes
  • Teresa Carvalho
  • Paulo Loureiro
  • Tânia Sousa
Case Report


Atheroembolic renal disease is caused by foreign-body reaction to cholesterol crystals flushed from the atherosclerotic plaques into the small-vessel system of the kidneys. It is an underdiagnosed entity, mostly related to vascular procedures and/or anticoagulation, and prognosis is considered to be poor. Besides the benefit of aggressive medical prevention of further embolic events, use of steroid therapy has been associated with greater survival. Here we report a case of a patient with a multisystemic presentation of the disease days after performance of percutaneous coronary intervention and anticoagulation initiation due to an episode of myocardial infarction. Renal, cutaneous, ophthalmic, neurological, and possibly muscular and mesenteric involvement was diagnosed. Although medical treatment with corticosteroids and avoidance of further anticoagulation was applied, the patient rapidly progressed to end-stage renal disease requiring hemodialysis and died 6 months after diagnosis. This is a case of catastrophic progression of the disease resistant to therapeutic measures. Focus on diagnosis and more efficient preventive and therapeutic protocols are therefore needed.


Atheroembolic Corticosteroids Hemodialysis Anticoagulation 


Conflict of interest

The authors declare that no conflict of interest exists.


  1. 1.
    Scolari F, Ravani P, Pola A, Guerini S, Zubani R, Movili E, et al. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. J Am Soc Nephrol. 2003;14:1584–90.PubMedGoogle Scholar
  2. 2.
    Modi KS, Rao VK. Atheroembolic renal disease. J Am Soc Nephrol. 2001;12:1781–7.PubMedGoogle Scholar
  3. 3.
    Thériault J, Agharazzi M, Dumont M, Pichette V, Ouimet D, Leblanc M. Atheroembolic renal failure requiring dialysis: potential for renal recovery? A review of 43 cases. Nephron Clin Pract. 2003;94(1):c11–8.PubMedGoogle Scholar
  4. 4.
    Scolari F, Ravani P, Gaggi R, Santostefano M, Rollino C, Stabellini N, et al. The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors. Circulation. 2007;116:298–304.PubMedGoogle Scholar
  5. 5.
    Meyrier A. Cholesterol crystal embolism: diagnosis and treatment. Kidney Int. 2006;69:1308–12.PubMedGoogle Scholar
  6. 6.
    Zucchelli P, Zuccala A. The diagnostic dilemma of hypertensive nephrosclerosis: the nephrologist’s view. Am J Kidney Dis. 1993;21:87–91.PubMedGoogle Scholar
  7. 7.
    Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. Angiology. 1987;38:769–84.PubMedGoogle Scholar
  8. 8.
    Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis. 1999;33:840–50.PubMedGoogle Scholar
  9. 9.
    Hasegawa M, Kawashima S, Shikano M, Hasegawa H, Tomita M, Murakami K, et al. The evaluation of corticosteroid therapy in conjunction with plasma exchange in the treatment of renal cholesterol embolic disease. A report of 5 cases. Am J Nephrol. 2000;20:263–7.PubMedGoogle Scholar
  10. 10.
    Fabbian F, Catalano C, Lambertini D, Bordin V, Di Landro D. A possible role of corticosteroids in cholesterol crystal embolization. Nephron. 1999;83:189–90.PubMedGoogle Scholar
  11. 11.
    Mann S, Sos T. Treatment of atheroembolization with corticosteroids. Am J Hypertens. 2001;14:831–4.PubMedGoogle Scholar
  12. 12.
    Stabellini N, Cerretani D, Russo G, Rizziolo E, Gilli P. Renal atheroembolic disease: evaluation of the efficacy of corticosteroid therapy. G Ital Nefrol. 2002;19:18–21.PubMedGoogle Scholar
  13. 13.
    Jones DB, Iannaccone PM. Atheromatous emboli in renal biopsies. Am J Pathol. 1975;78:261–71.PubMedGoogle Scholar
  14. 14.
    Greenberg A, Bastacky SI, Iqbal A, Borochovitz D, Johnson JP. Focal segmental glomerulosclerosis associated with nephrotic syndrome in cholesterol atheroembolism. Clinicopathological correlations. Am J Kidney Dis. 1997;29:334–44.PubMedGoogle Scholar
  15. 15.
    Thurlbeck WM, Castleman B. Atheromatous emboli to the kidney after aortic surgery. N Engl J Med. 1957;257:442–7.PubMedGoogle Scholar
  16. 16.
    Thadhani RI, Camargo C, Xavier RJ, Fang LT, Bazari H. Atheroembolic renal failure after invasive procedures. Natural history based on 52 histologically proved cases. Medicine. 1995;74:350–8.PubMedGoogle Scholar
  17. 17.
    Lye WC, Cheah JS, Sinniah R. Renal cholesterol embolic disease. Case report and review of the literature. Am J Nephrol. 1993;13:489–93.PubMedGoogle Scholar
  18. 18.
    Liew Y, Bartholomew J. Atheromatous embolization. Vasc Med. 2005;10:309–26.PubMedGoogle Scholar
  19. 19.
    Dahlberg PJ, Frecentese DF, Cogbill TH. Cholesterol embolism: experience with 22 histologically proven cases. Surgery. 1989;105:737–46.PubMedGoogle Scholar
  20. 20.
    Cogan E, Schandené L, Papadopoulos T, Crusiaux A, Goldman M. Interleukin-5 production by T lymphocytes in atheroembolic disease with hypereosinophilia. J Allergy Clin Immunol. 1995;96:427–9.PubMedGoogle Scholar
  21. 21.
    Kasinath BS, Corwin HL, Bidani AK, Korbet SM, Schwartz MM, Lewis EJ. Eosinophilia in the diagnosis of atheroembolic renal disease. Am J Nephrol. 1987;7:173–7.PubMedGoogle Scholar
  22. 22.
    Ballesteros AL, Bromsoms J, Vallés M, Llistosella E, Garijo G, Bernadó L, et al. Vasculitis look-alikes: variants of renal atheroembolic disease. Nephrol Dial Transplant. 1999;14:430–3.PubMedGoogle Scholar
  23. 23.
    Kaufman JL, Stark K, Brolin RE. Disseminated atheroemboli from extensive degenerative atherosclerosis of aorta. Surgery. 1987;102:63–70.PubMedGoogle Scholar
  24. 24.
    Sijpkens Y, Westendorp R, van Kemenade F, van Duinen S, Breedveld F. Vasculitis due to cholesterol embolism. Am J Med. 1997;102:302–3.PubMedGoogle Scholar
  25. 25.
    Cappiello RA, Espinoza LR, Adelman H, Aguilar J, Vasey FB, Germain BF. Cholesterol embolism: a pseudovasculitic syndrome. Semin Arthritis Rheum. 1989;18:240–6.PubMedGoogle Scholar
  26. 26.
    Sabatine MS, Oelberg DA, Mark EJ, Kanarek D. Pulmonary cholesterol crystal embolization. Chest. 1997;112:1687–92.PubMedGoogle Scholar
  27. 27.
    Stabellini N, Rizzioli E, Trapassi MR, Fabbian F, Catalano C, Gilli P. Renal cholesterol microembolism: is steroid therapy effective? Nephron. 2000;86:239–40.PubMedGoogle Scholar
  28. 28.
    Kodras K, Benesch T, Neumann I, Haas M. Comparison of two dialysers (AN69ST vs. FX100) for heparin-free dialysis in patients with oral anticoagulation. Blood Purif. 2008;26:226–30.PubMedGoogle Scholar
  29. 29.
    Lavaud S, Canivet E, Wuillai A, Maheut H, Randoux C, Bonnet JM, et al. Optimal anticoagulation strategy in haemodialysis with heparin-coated polyacrylonitrile membrane. Nephrol Dial Transplant. 2003;18:2097–104.PubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2010

Authors and Affiliations

  • Bernardo Faria
    • 1
    Email author
  • Joana Vidinha
    • 1
  • Cátia Pêgo
    • 1
  • Jesus Garrido
    • 1
  • Sérgio Lemos
    • 1
  • Carla Lima
    • 1
  • Giovanni Sorbo
    • 1
  • Edgar Lorga Gomes
    • 1
  • Teresa Carvalho
    • 2
  • Paulo Loureiro
    • 3
  • Tânia Sousa
    • 1
  1. 1.Nephrology and Dialysis UnitHospital São Teotónio-ViseuViseuPortugal
  2. 2.Department of PathologyHospital São Teotónio-ViseuViseuPortugal
  3. 3.Department of OphthalmologyHospital São Teotónio-ViseuViseuPortugal

Personalised recommendations