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MINERVA UROLOGICA E NEFROLOGICA
A Journal on Nephrology and Urology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
XVI CONGRESS DELLA SOCIETÀ ITALIANA DI NEFROLOGIA SEZIONE PIEMONTE-VALLE D’AOSTA
Castello di Rivoli, Rivoli (TO) October 10, 1998
Minerva Urologica e Nefrologica 2000 September;52(3):119-22
Acute renal failure due to cholesterol atheroembolism
Boero R., Borca M., Iadarola G. M., Rollino C., Pignataro A., Alfieri V., Ballario R., Quarello F.
A.S.L. 4 - Ospedale Giovanni Bosco - Torino Divisione di Nefrologia e Dialisi
Background. To describe the clinical aspects of renal failure due to cholesterol atheroembolism.
Methods. An hospital based observational study on renal failure due to cholesterol atheroembolism was carried out. Twenty-two cases (19 males, mean age 68 yrs, range 53-83 yrs) were identified from January 1992 to September 1998.
Results. Clinical symptoms were acute or rapidly progressive renal failure with blue toe and/or skin livedo reticularis in 13/22 cases (59%) and indolent progressive renal failure in 7/22 cases (32%). In 6/22 cases (27%) an abdominal organ involvement was evident; two (9%) had retinal cholesterol emboli, two (9%) peripheral and two (9%) central nervous system impairment. In 7 patients (32%) the cholesterol atheroembolism occurred spontaneously, while in 15 (68%) it followed invasive or interventional radiology (8 cases, 36%); cardiac or vascular surgery (4 cases, 18%); thrombolytic or anticoagulant therapy (3 cases, 14%). The time interval between the procedure at risk and the onset of symptoms or signs of cholesterol atheroembolism ranged between few hours to 60 days. Eleven patients (50%) required dialysis, which was then witheld in 4 cases (36%), owing to partial functional recovery after a median time of 30 days, ranging from 10 to 690 days. Median follow-up was 2.5 months (ranging from 2 days to 68 months), and eleven patients (50%) deceased.
Conclusions. Cholesterol atheroembolism is a cause of renal failure associated with high mortality rates; its prevention needs the skill of all physicians involved in the care of patients with severe atherosclerosis.