title: The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors.
abstract: BACKGROUND
  Atheroembolic renal disease (AERD) is caused by showers of cholesterol crystals released by eroded atherosclerotic plaques. Embolization may occur spontaneously or after angiographic/surgical procedures. We sought to determine clinical features and prognostic factors of AERD.
  
  
  RESULTS
  Incident cases of AERD were enrolled at multiple sites and followed up from diagnosis until dialysis and death. Diagnosis was based on clinical suspicion, confirmed by histology or ophthalmoscopy for all spontaneous forms and for most iatrogenic cases. Cox regression was used to model time to dialysis and death as a function of baseline characteristics, AERD presentation (acute/subacute versus chronic renal function decline), and extrarenal manifestations. Three hundred fifty-four subjects were followed up for an average of 2 years. They tended to be male (83%) and elderly (60% >70 years) and to have cardiovascular diseases (90%) and abnormal renal function at baseline (83%). AERD occurred spontaneously in 23.5% of the cases. During the study, 116 patients required dialysis, and 102 died. Baseline comorbidities, ie, reduced renal function, presence of diabetes, history of heart failure, acute/subacute presentation, and gastrointestinal tract involvement, were significant predictors of event occurrence. The risk of dialysis and death was 50% lower among those receiving statins.
  
  
  CONCLUSIONS
  Clinical features of AERD are identifiable. These make diagnosis possible in most cases. Prognosis is influenced by disease type and severity.
authors.affiliation: Division of Nephrology, University and Spedali Civili, Brescia, Italy. fscolar@tin.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Scolari
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Rossella
authors.initials: R
authors.lastname: Gaggi
authors.forename: Marisa
authors.initials: M
authors.lastname: Santostefano
authors.forename: Cristiana
authors.initials: C
authors.lastname: Rollino
authors.forename: Nevio
authors.initials: N
authors.lastname: Stabellini
authors.forename: Loredana
authors.initials: L
authors.lastname: Colla
authors.forename: Battista Fabio
authors.initials: BF
authors.lastname: Viola
authors.forename: Paolo
authors.initials: P
authors.lastname: Maiorca
authors.forename: Chiara
authors.initials: C
authors.lastname: Venturelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonardelli
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Barrett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017700:Embolism, Cholesterol / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies