title: Cholesterol crystal embolism syndrome in dialysis patients: an emerging clinical diagnosis?
abstract: BACKGROUND
  Cholesterol crystal embolism syndrome (CCE) is an increasing end-stage renal disease cause. Few cases have been described on dialysis, despite the high prevalence of the predisposing factors.
  
  
  METHODS
  The diagnostic criteria of the present study were: skin lesions, myalgia, fatigue, fever and acute inflammatory serologic signs, in the presence of severe vasculopathy. The precipitating factors were: anticoagulation, endovascular intervention and ulcerated atherosclerotic plaque.
  
  
  RESULTS
  Between October 2003 and September 2005, CCE was diagnosed in 6 dialysis patients (of 200-210 on chronic treatment): 5 males, 1 female, median age 59.5 years (47-70) and end-stage renal disease follow-up 11.5 years (3-25). All had severe vasculopathy, 5 cardiopathy, and 4 were failed graft recipients. The treatment included: peritoneal dialysis, daily dialysis, 'conventional' hemodialysis (2 cases) and hemodiafiltration. The diagnosis was based on the clinical-laboratory picture in 1 patient. In the 5 others clues were present (dicumarol therapy, angioplasty, femoral artery thrombosis, CCE predialysis and ulcerated aortic plaque). The therapeutic approach consisted of corticosteroids (5 cases), statins (4 cases) and prostaglandin analogues (4 cases).
  
  
  CONCLUSIONS
  The differential diagnosis of CCE should also be considered in dialysis patients (necrotic lesions, limb pain and vasculitis-like signs).
authors.affiliation: Nephrology, Internal Medicine Department, University of Turin, Turin, Italy. gbpiccoli@yahoo.it
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Roberta
authors.initials: R
authors.lastname: Fenoglio
authors.forename: Loredana
authors.initials: L
authors.lastname: Colla
authors.forename: Donatella
authors.initials: D
authors.lastname: Bilucaglia
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Mezza
authors.forename: Manuel
authors.initials: M
authors.lastname: Burdese
authors.forename: Francesca
authors.initials: F
authors.lastname: Bermond
authors.forename: Giuseppe Paolo
authors.initials: GP
authors.lastname: Segoloni
mesh_terms: D000368:Aged; D000818:Animals; D003937:Diagnosis, Differential; D017700:Embolism, Cholesterol / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D013577:Syndrome