title: Low-dose prednisolone ameliorates acute renal failure caused by cholesterol crystal embolism.
abstract: OBJECTIVE
  The prognosis of renal cholesterol crystal embolism (CCE) is poor. Although various treatments for CCE have been attempted, there is no optimal therapy. We tested the effect of low-dose prednisolone (PS) on CCE-related acute renal failure (ARF).
  
  
  METHODS
  7 patients (mean age 69 years) diagnosed with CCE-related ARF were treated with oral PS at 15-20 mg/day for 2-4 weeks, which was then tapered at 5 mg/day over 2-4 weeks, followed by 5 mg/day maintenance dose. Recurrent ARF during PS tapering was treated with a larger dose of PS.
  
  
  RESULTS
  Inciting factors were identified in four patients: coronary angiography (n=3) and cerebral angiography (n=1). On admission, serum creatinine (SCr) was 2.1 +/- 0.3 mg/dl (mean +/- SEM). SCr and eosinophil count before treatment were 4.2 +/- 0.4 mg/dl and 682 +/- 73/microl, respectively. PS therapy improved ARF in all cases at week 2 (SCr 3.8 +/- 0.5 mg/dl) parallel to a decrease in eosinophilia (116 +/- 30/microl), and at week 4 (3.1 +/- 0.4 mg/dl and 134 +/- 20/microl, respectively). At last follow-up, renal function was improved or maintained in 5 patients compared with that at week 4 post-treatment. One patient died of lung cancer. Another required LDL apheresis and hemodialysis but died due to CCE-related multi-organ failure. A third patient had recurrent ARF and was re-treated with a larger dose of PS, which resulted in an immediate decrease in SCr. However, the patient developed acute renal dysfunction due to congestive heart failure, and required hemodialysis.
  
  
  CONCLUSIONS
  Low-dose PS improved CCE-related ARF, probably through amelioration of inflammatory reaction surrounding affected renal vessels.
authors.affiliation: Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. mnakayama@qmed.hosp.go.jp
authors.forename: M
authors.initials: M
authors.lastname: Nakayama
authors.forename: M
authors.initials: M
authors.lastname: Nagata
authors.forename: T
authors.initials: T
authors.lastname: Hirano
authors.forename: K
authors.initials: K
authors.lastname: Sugai
authors.forename: R
authors.initials: R
authors.lastname: Katafuchi
authors.forename: S
authors.initials: S
authors.lastname: Imayama
authors.forename: N
authors.initials: N
authors.lastname: Uesugi
authors.forename: T
authors.initials: T
authors.lastname: Tsuchihashi
authors.forename: H
authors.initials: H
authors.lastname: Kumagai
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D017700:Embolism, Cholesterol / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D012867:Skin / Q000098:blood supply / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D011239:Prednisolone