Cholesterol crystal embolism (atheroembolism)

Overview

Cholesterol crystal embolism, known as atheroembolic disease, is caused by showers
of cholesterol crystals from an atherosclerotic plaque that occludes small arteries. Embolization
can occur spontaneously or as an iatrogenic complication from an invasive vascular
procedure (angiography or vascular surgery) and after anticoagulant therapy. The atheroembolism
can give rise to different degrees of renal impairment. Some patients show a moderate
loss of renal function, others severe renal failure requiring dialysis. Renal outcome can be variable:
some patients deteriorate or remain on dialysis, some improve and some remain with
chronic renal impairment. Clinically, three types of atheroembolic renal disease have been described:
acute, subacute or chronic. More frequently a progressive loss of renal function occurs
over weeks. Atheroembolization can involve the skin, gastrointestinal system and central nervous
system. The diagnosis is difficult and controversial for the protean extrarenal manifestations.
In the past, the diagnosis was often made post-mortem. In the last 10 yrs, awareness of
atheroembolic renal disease has improved. The correct diagnosis requires the clinician to be
alert. The typical patient is a white male aged >60 yrs with a history of hypertension, smoking and
arterial disease. The presence of a classic triad (precipitating event, renal failure and peripheral
cholesterol crystal embolization) suggests the diagnosis. This can be confirmed by a biopsy of
the target organs. A specific treatment is lacking; however, it is an important diagnosis to make
because an aggressive therapeutic approach can be associated with a more favorable clinical
outcome. (Heart International 2006; 3-4: 155-60)

Keywords

Cholesterol crystals, Renal atheroembolic disease, Atherosclerosis

Correspondence

Francesco Scolari, MD, Scuola di Specializzazione in Nefrologia Clinica, Università degli Studi di Brescia, UO Nefrologia, Spedali Civili, Pzle Spedali Civili 1, 25100 Brescia – Italy, fscolar@tin.it