The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors.
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.
Scolari
Francesco
F
Division of Nephrology, University and Spedali Civili, Brescia, Italy. fscolar@tin.it
Ravani
Pietro
P
Gaggi
Rossella
R
Santostefano
Marisa
M
Rollino
Cristiana
C
Stabellini
Nevio
N
Colla
Loredana
L
Viola
Battista Fabio
BF
Maiorca
Paolo
P
Venturelli
Chiara
C
Bonardelli
Stefano
S
Faggiano
Pompilio
P
Barrett
Brendan J
BJ
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