Renal transplantation in a patient with end stage renal disease due to cholesterol embolism.
BACKGROUND
Renal failure due to cholesterol emboli is mostly irreversible. Therefore chronic renal replacement therapy is necessary. However, to the best of our knowledge no published experience exists with renal transplantation in patients with end-stage renal disease (ESRD) due to cholesterol embolization (CE).


METHODS
Renal transplantation was performed in a 64-year-old man who suffered from ESRD due to CE after coronary angiography. Because our patient presented with a typical profile of cardiovascular risk factors effective long-term control of these risk factors before and after transplantation was a mandatory prerequisite before considering transplantation.


RESULTS
After one rejection episode serum creatinine values have been stable and no major complications have occurred during a follow-up of 18 months. No signs of recurrent cholesterol emboli into the donated kidney were seen in renal biopsies performed due to graft rejection.


CONCLUSIONS
Cholesterol embolization is an uncommon reason for ESRD and mainly occurs after invasive vascular procedures in patients with hyperlipidemia, arterial hypertension, and smoking. Because ESRD due to CE often is irreversible, chronic renal replacement therapy may be necessary. As demonstrated in our report, renal transplantation should be considered. However, in this setting effective long-term control of the underlying risk factors before and after renal transplantation has to be ensured.
Kammerl
M C
MC
Klinik und Poliklinik für Innere Medizin II, Klinik und Poliklinik für Chirurgie, and Institut für Pathologie, University of Regensburg, Germany.
Fischereder
M
M
Zülke
C
C
Obermann
E C
EC
Anthuber
M
M
Riegger
G A
GA
Krämer
B K
BK
D017700:Embolism, Cholesterol / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome