Cholesterol embolization (CE), usually occurring in males in their six
th or seventh decade of life, can affect multiple organ systems, inclu
ding the kidney. Interventive diagnostic procedures and aortic surgery
greatly increase the risk of CE. Rapid or insidious progression of re
nal failure in association with surgical or diagnostic radiologic proc
edures should suggest this diagnosis. Progressive rend insufficiency i
n older patients with generalized arterial disease should suggest isch
emic nephropathy secondary to bilateral renal artery stenosis, renal C
E, or both. Recent worsening of hypertension is characteristic of eith
er diagnosis. A number of clinical conditions can simulate renal CE, a
nd final differentiation may be possible only by renal biopsy. Aggress
ive, supportive management of renal CE is warranted because renal func
tion may stabilize and, in a limited number of cases, may even improve
.