title: Cholesterol crystal embolization (CCE): Improvement of renal function with high-dose corticosteroid treatment.
abstract: Cholesterol crystal embolization (CCE) is an important and often under-diagnosed cause of renal insufficiency in patients with atherosclerosis. So far, only statins are the mainstay of therapy and the role of corticosteroids is controversial. We describe a 57-year-old gentleman who presented with accelerated hypertension and renal failure three months after coronary angiogram. Renal biopsy showed cholesterol clefts in the arteriole. Initially, management with anti-hypertensives alone (already receiving statins since angiogram) was unsuccessful. A trial of high-dose corticosteroids resulted in an improvement of the general condition in the next two days, and the serum creatinine reduced gradually to 1.6 mg/dL over the next one month. In conclusion, high-dose corticosteroids are useful in the treatment of CCE associated renal failure, especially in cases with no spontaneous recovery of function.
authors.affiliation: Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Madhav
authors.initials: M
authors.lastname: Desai
authors.forename: R
authors.initials: R
authors.lastname: Ram
authors.forename: Aruna
authors.initials: A
authors.lastname: Prayaga
authors.forename: K V
authors.initials: KV
authors.lastname: Dakshinamurty
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D017023:Coronary Angiography / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D017700:Embolism, Cholesterol / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007668:Kidney / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000959:Antihypertensive Agents; D015415:Biomarkers; D003404:Creatinine