Postinterventionelles Cholesterinemboliesyndrom

Abstract

A 73-year old woman was admitted to the hospital because of progressive renal failure with onset 2 months after an angiogram of the legs. She had diabetes mellitus and was hypertensive. Her feet were cold, painful and showed irregular blue and purple discolorations. Blood pressure was 170/80 mmHg, heart rate 72 bpm. Serum creatinine was 6,7 mg/dl (eGFR 7 ml/min) and she had proteinuria of 4,3 g/l. The erythrocyte sedimentation rate was markedly elevated, she had eosinophilia and hypocomplementemia. Because of the acute renal failure and proteinuria a renal biopsy was taken, as well as a skin biopsy from the patients foot. Both biopsies showed cholesterol crystal emboli with elongated, biconvex transparent clefts and an inflammatory reaction of the vessel wall which had caused obstruction. Renal function did not recover, and the patient was transferred to the chronic dialysis program. Treatment with a statin was initiated and her blood pressure normalized. In most cases cholesterol crystal embolism is iatrogenic. This multiorgan syndrome occurs in patients at high risk of cardiovascular disease. Cholesterol crystals from ruptured atheromatous plaques become lodged in peripheral arteries and induce an obliterating inflammation of the vessel wall. Mortality is high (about 38 %).