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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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  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

language: Italian

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


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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.

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