[Cholesterol embolism--a serious systemic disease].
The syndrome of cholesterol embolism is a multiorgan disorder caused by peripheral embolization of cholesterol crystals from an ulcerated aorta plaque. The kidney is the organ most often affected (approx 50%). Prognosis is poor, with a mortality of about 70%. We describe two of four cases of cholesterol embolism diagnosed during the autumn of 1997. All were elderly men with advanced generalized atherosclerosis. Positive diagnosis upon renal biopsy required demonstrating cholesterol crystals in renal interlobar and arcuate arteries. Workups for progressive renal failure were performed due to suspected vasculitis in three cases and radiologically induced renal damage subsequent to coronary angiography in another. None of the patients showed renal vasculitis upon biopsy, but one who was ANCA positive developed vasculitis after a few months. Three patients died within a couple of months of onset. The patient with renal vasculitis was treated with cyclophosphamide and steroids, and survives one and a half years after onset. It is vital to consider the diagnosis cholesterol embolism whenever an elderly patient with pronounced atherosclerosis develops progressive renal failure and multi-organ failure. Angiography, aorto-iliaco-femoral surgery and thrombolytic therapy increase the risk of cholesterol embolism in this group. There is no effective therapy. The key is prophylaxis, which means identifying patients at risk prior to invasive vascular procedures.
Palmgren
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Njurmedicinska avdelningen, Universitetssjukhuset, Sahlgrenska, Göteborg.
Hartford
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Herlitz
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H
D000368:Aged; D000792:Angiography / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D003937:Diagnosis, Differential; D017700:Embolism, Cholesterol / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D014657:Vasculitis / Q000150:complications / Q000209:etiology / Q000473:pathology