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Long-term outcome of biopsy-proven cholesterol crystal embolism

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Abstract

Background

Cholesterol crystal embolism (CCE) causes renal damage, and there is an extremely high risk of end-stage renal disease. However, the time course of CCE-related renal deterioration varies and little is known about the subsequent risk of dialysis among patients with biopsy-proven CCE.

Methods

We performed a retrospective cohort study of 38 Japanese patients in whom a histological diagnosis of CCE was made from September 1992 to July 2005. Competing risk regression analysis was used to investigate the association between declining renal function ( ≥ 1.5 elevation of serum creatinine within 26 weeks after CCE) or its subtypes (acute [ < 1 week after CCE], subacute [1 to < 6 weeks], and chronic [6 to < 26 weeks]) and the risk of dialysis, with adjustment for age, baseline serum creatinine, and the precipitating event (iatrogenic or spontaneous).

Results

During a median follow-up period of 25.9 weeks, 14 patients (35.9%) started dialysis. Multivariable analysis showed that patients with declining renal function had a higher risk of commencing dialysis than those without declining function (subdistribution hazard ratio [SHR] 9.47; 95% confidence interval [CI] 1.34–66.8). Patients with different renal presentations had a similarly increased risk of commencing dialysis, with the risk being significantly higher for the subacute and chronic patterns of declining renal function (adjusted SHR [95% CI] for acute, subacute, and chronic declining renal function[vs. no decline]: 7.36 [0.85–63.6], 11.9 [1.36–101], and 10.7 [1.49–77.0], respectively).

Conclusion

Declining renal function after CCE, even later than 6 weeks, was significantly associated with the subsequent risk of dialysis.

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Abbreviations

CCE:

Cholesterol crystal embolism

SHR:

Subdistribution hazard ratio

CI:

Confidence interval

BP:

Blood pressure

CAG:

Coronary angiography

PCI:

Percutaneous coronary intervention

CABG:

Coronary artery bypass grafting

TACE:

Transcatheter arterial chemoembolization

PTA:

Percutaneous transluminal angioplasty

CKD:

Chronic kidney disease

IQR:

Interquartile range

References

  1. Jucgla A, Moreso F, Muniesa C, Moreno A, Vidaller A. Cholesterol embolism: still an unrecognized entity with a high mortality rate. J Am Acad Dermatol. 2006;55(5):786–93.

    Article  PubMed  Google Scholar 

  2. Donohue KG, Saap L, Falanga V. Cholesterol crystal embolization: an atherosclerotic disease with frequent and varied cutaneous manifestations. JEADV. 2003;17(5):504–11.

    CAS  PubMed  Google Scholar 

  3. Scolari F, Ravani P, Gaggi R, et al. The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors. Circulation. 2007;116(3):298–304.

    Article  PubMed  Google Scholar 

  4. Li X, Bayliss G, Zhuang S. Cholesterol crystal embolism and chronic kidney disease. Int J Mol Sci. 2017;18:6.

    Google Scholar 

  5. Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.

    Article  CAS  PubMed  Google Scholar 

  6. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  7. Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis. 1999;33(5):840–50.

    Article  CAS  PubMed  Google Scholar 

  8. Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am College Cardiol. 2003;42(2):211–6.

    Article  Google Scholar 

  9. Scolari F, Ravani P. Atheroembolic renal disease. Lancet (London, England). 2010;375(9726):1650–60.

    Article  Google Scholar 

  10. Kronzon I, Saric M. Cholesterol embolization syndrome. Circulation. 2010;122(6):631–41.

    Article  PubMed  Google Scholar 

  11. Ozkok S, Ozkok A. Contrast-induced acute kidney injury: a review of practical points. World J Nephrol. 2017;6(3):86–99.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lin PH, Bush RL, Conklin BS, et al. Late complication of aortoiliac stent placement- atheroembolization of the lower extremities. J Surg Res. 2002;103(2):153–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank all of the physicians involved in patient care at Toranomon Hospital.

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Authors and Affiliations

  1. Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan

    Naoya Toriu, Keiichi Sumida, Hiroki Mizuno, Eiko Hasegawa, Tatsuya Suwabe, Masahiro Kawada, Toshiharu Ueno, Noriko Hayami, Akinari Sekine, Rikako Hiramatsu, Masayuki Yamanouchi, Junichi Hoshino, Naoki Sawa, Kenmei Takaichi & Yoshifumi Ubara

  2. Department of Pathology, Toranomon Hospital, Tokyo, Japan

    Kenichi Ohashi & Takeshi Fujii

  3. Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

    Junichi Hoshino, Kenmei Takaichi & Yoshifumi Ubara

  4. Department of Pathology, Yokohama City Hospital, Yokohama, Kanagawa, Japan

    Kenichi Ohashi

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  1. Naoya Toriu
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  2. Keiichi Sumida
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Corresponding authors

Correspondence to Naoya Toriu or Yoshifumi Ubara.

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The present report adhered to the Declaration of Helsinki.

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Toriu, N., Sumida, K., Mizuno, H. et al. Long-term outcome of biopsy-proven cholesterol crystal embolism. Clin Exp Nephrol 23, 1181–1187 (2019). https://doi.org/10.1007/s10157-019-01749-y

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  • DOI: https://doi.org/10.1007/s10157-019-01749-y

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