Abstract
Renal cholesterol crystal embolism (also called renal atheroembolism) is a cause of acute kidney injury with increasing frequency. It is usually seen in patients older than 60 years of age with diffuse atherosclerotic disease. Although it develops usually following vascular interventions; it may occur spontaneously. It presents with partial or total occlusion of small arteries due to distal embolization from cholesterol crystals from ruptured atherosclerotic plaques. It is in fact a part of systemic disease called cholesterol crystal embolization disease affecting kidneys, eyes, brain and gastrointestinal system. Livedo reticularis, especially purple discoloration of toes are clues for diagnosis. The pathognomonic finding of renal cholesterol crystal embolism is the cholesterol crystal clefts in renal biopsy specimen. Herein, we present a atypical case of acute kidney injury due to spontaneous cholesterol crystal embolization in a patient with functionally solitary kidney.
Highlights
Renal cholesterol crystal embolism (RCCE; called renal atheroembolism) is one of the reasons of acute kidney injury with increasing frequency. It usually occurs in patients older than 60 years of age with diffuse atherosclerotic disease [1]
RCCE is a part of the cholesterol
With the increasing incidence of cardiovascular disease and so, vascular interventions; RCCE became a more frequent reason for acute kidney injury. It usually occurs in patients older than 60 years of age with diffuse atherosclerotic disease [1].The incidence was reported to be 7.1% in a study examining 259 patients older than 60 years who were biopsied due to acute kidney injury [8]
Summary
Renal cholesterol crystal embolism (RCCE; called renal atheroembolism) is one of the reasons of acute kidney injury with increasing frequency. It usually occurs in patients older than 60 years of age with diffuse atherosclerotic disease [1]. The laboratory tests in another center revealed that urea (140 mg/dl) and creatinin (7.6 mg/dl) levels were elevated He was referred to our clinic where the urinary system ultrasonography revealed the sizes of the left and the right kidneys as 111x73 mm and 76x32 mm, respectively, with the echogenity of both kidneys increased. Immunofluorescence examination was normal and there was no staining with Congo dye He was diagnosed as spontaneous RCCE superimposed on primary nephrosclerosis. His renal functions did not improve during follow-up and he is still on hemodialysis program three times a week
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