Atheroembolic renal disease with rapid progression and fatal outcome.
Atheroembolic renal disease is caused by foreign-body reaction to cholesterol crystals flushed from the atherosclerotic plaques into the small-vessel system of the kidneys. It is an underdiagnosed entity, mostly related to vascular procedures and/or anticoagulation, and prognosis is considered to be poor. Besides the benefit of aggressive medical prevention of further embolic events, use of steroid therapy has been associated with greater survival. Here we report a case of a patient with a multisystemic presentation of the disease days after performance of percutaneous coronary intervention and anticoagulation initiation due to an episode of myocardial infarction. Renal, cutaneous, ophthalmic, neurological, and possibly muscular and mesenteric involvement was diagnosed. Although medical treatment with corticosteroids and avoidance of further anticoagulation was applied, the patient rapidly progressed to end-stage renal disease requiring hemodialysis and died 6 months after diagnosis. This is a case of catastrophic progression of the disease resistant to therapeutic measures. Focus on diagnosis and more efficient preventive and therapeutic protocols are therefore needed.
Nephrology and Dialysis Unit, Hospital São Teotónio-Viseu, Av Rei Dom Duarte, 3504 509 Viseu, Portugal. faria_bernardo@yahoo.com
Bernardo
B
Faria
Joana
J
Vidinha
Cátia
C
Pêgo
Jesus
J
Garrido
Sérgio
S
Lemos
Carla
C
Lima
Giovanni
G
Sorbo
Edgar Lorga
EL
Gomes
Teresa
T
Carvalho
Paulo
P
Loureiro
Tânia
T
Sousa
D000368:Aged; D017700:Embolism, Cholesterol / Q000150:complications* / Q000276:immunology / Q000401:mortality* / Q000473:pathology; D017809:Fatal Outcome; D005549:Foreign-Body Reaction / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology; D008297:Male; D006435:Renal Dialysis