Clinical presentation, evaluation, and treatment of renal atheroemboli
- Francesco Scolari, MD
Francesco Scolari, MD
- Professor of Nephrology
- University of Brescia
Renal and systemic atheroemboli (also called cholesterol crystal emboli) usually affect older patients with diffuse erosive atherosclerosis. Cholesterol crystal embolization occurs when portions of an atherosclerotic plaque break off and embolize distally, resulting in partial or total occlusion of multiple small arteries (or glomerular arterioles), leading to tissue or organ ischemia .
Clinical issues related to renal atheroemboli will be reviewed here. Discussions of cholesterol crystal embolization in general and thromboembolic renal infarction are presented separately. (See "Embolism from atherosclerotic plaque: Atheroembolism (cholesterol crystal embolism)" and "Renal infarction".)
Atheroembolization is a complication of severe atherosclerosis. Thus, risk factors for atheroembolic disease, such as older age, male sex, diabetes, arterial hypertension, hypercholesterolemia, and cigarette smoking, are the same as for the development of atherosclerosis [2-7]. (See "Overview of established risk factors for cardiovascular disease", section on 'Established risk factors for atherosclerotic CVD'.)
Inciting events — Once formed, an atherosclerotic plaque may be disrupted by a variety of inciting events, producing cholesterol crystal emboli. These inciting events can be classified broadly into the following:
●Iatrogenic event, usually induced by angiography, cardiovascular surgery, or anticoagulationTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- RISK FACTORS
- Inciting events
- CLINICAL PRESENTATION
- Kidney injury
- Urinary findings
- Eosinophilia and hypocomplementemia
- EVALUATION AND DIAGNOSIS
- History and physical examination
- Laboratory studies
- Tissue biopsy
- Differential diagnosis
- TREATMENT AND PROGNOSIS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS