CHOLESTEROL ATHEROMATOUS EMBOLISM - AN INCREASINGLY RECOGNIZED CAUSE OF ACUTE-RENAL-FAILURE

Background. Cholesterol atheromatous embolism is a systemic disease re sulting from cholesterol crystal embolization to many organs, includin g the kidney. Vascular surgery, vascular radiology investigations and anticoagulation have been identified as inciting factors. Methods. Fif teen patients with extensive atherosclerosis, presenting with simultan eous occurrence of acute renal failure and peripheral ischaemic change s were diagnosed as having acute renal failure due to cholesterol athe romatous embolism. Results. The patients, 12 men and three women, had an average age of 65 years. In one patient, spontaneous occurrence of the disease was observed. An inciting factor was identified in 14 pati ents: aortography in 10, aortic surgery in two, and thrombolysis in tw o. Clinical course of acute renal failure was quite variable. Four pat ients required dialysis; 11 were conservatively managed. All patients had concomitant skin lesions, including digital mottling, cyanosis and gangrene of the toes, and livedo reticularis of the lower limb and ab domen. Eosinophilia was the most common laboratory abnormality. The di agnosis of cholesterol atheromatous embolism was confirmed by tissue e xamination in eight; in three it was based on the finding of retinal c holesterol emboli; in four patients it was made on clinical grounds. S even patients died within 36 months. Death was most commonly from card iac causes. Conclusions. Since the population at risk for cholesterol embolism is growing and the disease is iatrogenic in origin, we should expect to detect cholesterol embolism with greater frequency as cause of acute renal failure in the future.