Clinical and Experimental Nephrology

, Volume 7, Issue 1, pp 0067–0071 | Cite as

Acute renal failure due to cholesterol crystal embolism treated with LDL apheresis followed by corticosteroid and candesartan

  • K. Tamura
  • M. Umemura
  • H. Yano
  • M. Sakai
  • Y. Sakurai
  • Y. Tsurumi
  • Y. Koide
  • T. Usui
  • M. Yabana
  • Y. Toya
  • Y. Tokita
  • S. Umemura
CASE REPORT

Abstract

Cholesterol crystal embolism (CCE) is caused by the shedding of cholesterol crystals into the bloodstream, and it has been recently recognized as a serious complication after vascular procedures. Our case of CCE, which was diagnosed by skin and renal biopsies, occurred in a patient with hypertension and diabetes mellitus, 3 months after coronary angiography, with the development of renal failure and blue toes. After low-density lipoprotein apheresis (LDL-A), the skin lesions, including livedo reticularis and pain from the acrocyanotic toes, dramatically improved, with partial recovery of renal function. Following the administration of low-dose corticosteroid and candesartan – an angiotensin II type 1 receptor antagonist (ARB) – the eosinophilia disappeared and renal function improved gradually with a decrease in urinary protein excretion. Therefore, a combination therapy of LDL-A, low-dose corticosteroid, and an ARB is a possible treatment for CCE, although the possibility of spontaneous recovery of renal function cannot be eliminated for this patient.

Key words Cholesterol crystal embolism Acute renal failure Low-density lipoprotein apheresis Corticosteroid Angiotensin II type 1 receptor antagonist 

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Copyright information

© Japan Society of Nephrology 2003

Authors and Affiliations

  • K. Tamura
    • 1
  • M. Umemura
    • 3
  • H. Yano
    • 3
  • M. Sakai
    • 1
  • Y. Sakurai
    • 2
  • Y. Tsurumi
    • 2
  • Y. Koide
    • 1
  • T. Usui
    • 3
  • M. Yabana
    • 1
  • Y. Toya
    • 1
  • Y. Tokita
    • 2
  • S. Umemura
    • 1
  1. 1.Second Department of Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan Tel. +81-45-787-2635; Fax +81-45-701-3738 e-mail: tamukou@med.yokohama-cu.ac.jpJP
  2. 2.Renal Division, Department of Medicine, Fujisawa Municipal Hospital, Fujisawa, JapanJP
  3. 3.Cardiovascular Division, Department of Medicine, Fujisawa Municipal Hospital, Fujisawa, JapanJP

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