Acute renal failure due to cholesterol crystal embolism treated with LDL apheresis followed by corticosteroid and candesartan.
Cholesterol crystal embolism (CCE) is caused by the shedding of cholesterol crystals into the bloodstream, and it has been recently recognized as a serious complication after vascular procedures. Our case of CCE, which was diagnosed by skin and renal biopsies, occurred in a patient with hypertension and diabetes mellitus, 3 months after coronary angiography, with the development of renal failure and blue toes. After low-density lipoprotein apheresis (LDL-A), the skin lesions, including livedo reticularis and pain from the acrocyanotic toes, dramatically improved, with partial recovery of renal function. Following the administration of low-dose corticosteroid and candesartan--an angiotensin II type 1 receptor antagonist (ARB)--the eosinophilia disappeared and renal function improved gradually with a decrease in urinary protein excretion. Therefore, a combination therapy of LDL-A, low-dose corticosteroid, and an ARB is a possible treatment for CCE, although the possibility of spontaneous recovery of renal function cannot be eliminated for this patient.
Second Department of Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. tamukou@med.yokohama-cu.ac.jp
Kouichi
K
Tamura
Masanari
M
Umemura
Hideto
H
Yano
Masashi
M
Sakai
Yoko
Y
Sakurai
Yuko
Y
Tsurumi
Yuichi
Y
Koide
Takashi
T
Usui
Machiko
M
Yabana
Yoshiyuki
Y
Toya
Yasuo
Y
Tokita
Satoshi
S
Umemura
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles / Q000627:therapeutic use*; D001706:Biopsy; D001713:Biphenyl Compounds; D001781:Blood Component Removal; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D003460:Crystallization; D017700:Embolism, Cholesterol / Q000150:complications* / Q000175:diagnosis; D004804:Eosinophils; D006801:Humans; D007668:Kidney / Q000473:pathology; D007958:Leukocyte Count; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria; D006435:Renal Dialysis; D012867:Skin / Q000473:pathology; D013777:Tetrazoles / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D008077:Lipoproteins, LDL; D013777:Tetrazoles; D002097:C-Reactive Protein; D011239:Prednisolone; D003404:Creatinine; C081643:candesartan