Cholesterol Emboli Research Articles

The Controversial Role of Glucocorticoids in Atheroembolic Renal Disease: A Narrative Review

Cholesterol crystal embolism (CCE) is an underrecognized multisystemic disease caused by the displacement of cholesterol crystals from atheromatous aortic plaques to distal vascular beds, leading to ischemic injury of target organs, particularly the kidneys, i.e., atheroembolic renal disease (ARD). According to recent research, cellular necrosis, induced by crystal-induced cytotoxicity, enhances the autoinflammatory cascade of the NLPR3 inflammasome, leading in turn to the so-called “necroinflammation”. The purported involvement of the latter in CCE offers a rationale for the therapeutic approach with anti-inflammatory drugs such as glucocorticoids, the use of which has long been a matter of debate in CCE. Diagnostic delay and no consistent evidence regarding efficacious treatment, leading to inconsistency in clinical practice, may worsen the already poor prognosis of ARD. The possible role of glucocorticoids in the treatment of ARD is thereby herein explored in a narrative fashion, analyzing the limited data from case reports and clinical trials.

Trash Feet and Mesenteric Ischemia as a Rare Manifestation of a Complicated Abdominal Aortic Aneurysm: A Case Report.

Abdominal aortic aneurysms and atheromatous plaques are well-established potential culprits in the development of cholesterol embolization. This embolic phenomenon can result in the occlusion of peripheral arteries in the forefoot or toes, commonly referred to as "trash foot". A 61-year old patient exhibited severe symptoms and signs of lower limb and mesenteric ischemia, represented clinically by abdominal pain, hematochezia, and bilateral plantar necrotic lesions, attributed to embolization from a previously unknown large infrarenal abdominal aortic aneurysm. Diagnosis was confirmed by performing angio-CT of the abdomen, an angiologic examination, as well as colonoscopy. The patient underwent open surgical repair of the aortic aneurysm and received intravenous prostanoids, resulting in a successful outcome with resolution of bowel ischemia and complete recovery of bilateral foot lesions with no tissue loss. Cholesterol embolization syndrome seldom manifests with its complete clinical spectrum. Identifying and addressing the underlying cause is crucial, with a focus on potential abdominal aortic aneurysms. A combined approach involving surgical repair and prostanoid therapy may offer a viable option for patients experiencing severe manifestations.

Diagnosis and Therapy of Atheroscerotic Renal Artery Stenosis - Update 2024

Abstract Atherosclerotic renal artery stenosis (ARAS), an increasingly recognized disorder, may cause ischemic nephropathy and renovascular hypertension, that may occur separately or together. Patients with chronic kidney disease (CKD) resulting from atherosclerotic renal artery stenosis usually have high-grade stenosis of both renal arteries or stenosis to a solitary functioning kidney. Patients at risk for bilateral renal artery stenosis are also at risk for other disorders that can present with similar clinical findings but cannot be corrected by surgery or angioplasty; these include hypertensive nephrosclerosis and atheroembolic kidney disease. In clinical decision-making about screening for and therapy of ARAS, we balance the chance of improving renal function and blood pressure with the risks of interventional procedures. In this article we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. The rapid progress in this field necessitates an update. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.

Non-neoplastic Kidney Diseases in Adult Tumor Nephrectomy and Nephroureterectomy Specimens in a Southeast Asian Tertiary Medical Center

OBJECTIVE: Non-neoplastic kidney diseases are concurrently present in up to 15% of patients with renal and ureteral tumors, which have been most studied in the United States. This study was conducted to determine the prevalence and spectrum of renal parenchymal diseases in similar patients from a Southeast Asian academic institution.METHODS: We searched the database of the Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University (2012–2022) and found 194 adult nephrectomy and nephroureterectomy specimens with renal, renal pelvis, and ureteral tumors. Additional stains included periodic acid-Schiff, methenamine silver, and Masson trichrome. Direct immunofluorescence microscopy was performed on the paraffin tissue sections for immunoglobulin (Ig) G, IgA, IgM, and kappa and lambda light chains. Clinical information, including age, gender, and co-morbidities, was obtained from the electronic medical records.RESULTS: Analysis of the 194 cases demonstrated the average age was 61 years (range: 17-89 years), with 126 males (65%) and 68 females (35%). After re-examination of the non-neoplastic renal parenchyma, 14 cases (7%) had diffused and/or nodular mesangial sclerosis. Diabetic nephropathy (12 cases) and idiopathic nodular glomerulosclerosis (2 cases) were diagnosed and associated with either stage 1 or 2 genitourinary cancers. Another case was diagnosed with atheroembolic renal disease. In all cases, the concurrent renal diseases were not identified during the initial evaluation.CONCLUSION: Examination of the non-neoplastic renal parenchyma is important to identify non-neoplastic kidney diseases, such as diabetic nephropathy, so early treatment may result in improved clinical outcomes for kidney and urothelial cancer patients.

Occlusive cutaneous vasculopathies as cause of chronic ulcers.

The term occluding vasculopathies covers a large number of different conditions. These often manifest as skin ulcers. Occluding vasculopathies should be considered in the differential diagnosis of leg ulcers. The term "occlusive vasculopathies" encompasses pathophysiologically related entities that share structural or thrombotic obliteration of small cutaneous vessels. In this article, we will focus on livedoid vasculopathy with and without antiphospholipid syndrome and calciphylaxis with differentiation from hypertonic leg ulcer as the most relevant differential diagnoses of leg ulcer. The term also includes vascular occlusion, for example due to oxalate or cholesterol embolism, and septic vasculopathy. This often leads to acral ulceration and is therefore not a differential diagnosis with classic leg ulcers. It will not be discussed in this article. Occlusive vasculopathy may be suspected in the presence of the typical livedo racemosa or (non-inflammatory) retiform purpura as a sign of reduced cutaneous perfusion in the wound area. Inflammatory dermatoses, especially vasculitides, must be differentiated. This is achieved by histopathological evaluation of a tissue sample of sufficient size and depth taken at the appropriate time. In addition, specific laboratory parameters, particularly coagulation parameters, can support the diagnosis.

A classic and an unusual presentation of atheroembolic renal disease

A classic and an unusual presentation of atheroembolic renal disease

THE CHALLENGE OF KIDNEY DAMAGE DURING INTERVENTIONAL CARDIOLOGY PROCEDURES

Introduction: Contrast nephropat(CN) is a frequent cause of acute renal failure (ARF). The diagnosis is based on an elevation of serum creatinine of 0.5 mg/dl (= 44.2 µmol/l) and/or ? 25% of baseline creatinine. In 90% of patients developing AKI on PC, it classically occurs between 24 and 72 hours after the examination. Diuresis is generally preserved, proteinuria is minimal, and urine sediment shows only granular cylinders and few cells. The differential diagnosis is that of ARF caused by cholesterol emboli from invasive procedures in the suprarenal aorta. In the short term, AKI following coronary angiography is associated with procedural complications, a longer hospital stay (8.1 days versus 4.7 days p < 0.001), and higher one-year mortality (12.1% versus 3.7%). Patients at risk of developing PC-related nephropathy, particularly those with chronic renal failure or concomitant hypovolemia, have the need for extrarenal purification in some cases, in addition to the risk of cardiovascular mortality. This makes contrast media nephropathy a serious event for which clinicians must be prepared. Objective:the aim of this work was to determine the incidence of NIPC in patients undergoing primary angioplasty and/or coronary angiography procedures and generate hypotheses about risk factors. Materials and methods In collaboration with the cardiology department, we conducted a longitudinal descriptive study between January 2019 and January 2021. It included a cohort of 180 patients undergoing emergency or cold angiocoronary angiography for diagnostic or therapeutic purposes. Clinical and biological follow-up was 3 months for all patients. Patients with a blood test including creatininelevels before the examination and creatinine levels at 3 days, 15 days, 1 month, and 3 months after the procedure were included. Those who had undergone PCI for anexamination other than coronary Results Characteristics of the overall population All patients hadnormal creatinine levels and were predominantly male (70.0%) with an average age of 60.8 years. Of these patients, 20.6% had diabetes, 18.2% hypertension and 6.4% heart failure (HF). The rate of IR was 20.8%. Descriptive study Comparison of patient characteristics with and without NCI: The multivariate logistic regression study demonstrated that diabetes mellitus (Odds Ratio (OR)=2.26 95% confidence interval (CI95%): 1.29-3.98, p=0.005), a left ventricular ejection fraction (LVEF) < 45% (OR=2. 03 IC95% :1.22-3.39, p=0.007) and a quantity of iodinated contrast medium (ICP) > 90ml (1.72 IC95%:.of iodinated contrast medium (ICP) > 90ml (1.72 IC95%: 0.99-2.99, p=0.05) were predictive of the occurrence of NCI. It should be noted that age was linked to creatinine clearance, and it was through a reduction in renal function that advanced age was responsible for a higher incidence of CIN. Furthermore, the search for correlations between these five independent factors 2 by 2 showed a significant relationship between diabetes and reduced renal function in the co-presence of these two factors, their effects are reciprocally potentiated and are responsible for an increased risk. Preventive measures showed? their efficacý only in the diabetic group, where prior hydration with saline significantly reduced the incidence of CIN: 16% versus 50% in diabetics who did not receive saline infusion Conclusion: Despite current management, this pathology affects the cardiovascular prognosis of patients, even though normalization of renal function is usually achieved within a month of exploration. In addition to identifying factors predictive of NIPC with a view to implementing appropriate preventive measures in patients at risk, we stress the importance of ensuring a good hemodynamic state intra-procedurally27.

P09 A catastrophic decline: a significant skin rash in a patient presenting with catastrophic antiphospholipid syndrome

P09 A catastrophic decline: a significant skin rash in a patient presenting with catastrophic antiphospholipid syndrome

Blue toe syndrome caused by spontaneous cholesterol embolization syndrome.

Blue toe syndrome is a severe cutaneous manifestation of cholesterol embolisation syndrome (CES). Approximately 80% of CES cases are iatrogenic; however, CES can also be spontaneous. We report a 61-year-old man who presented with bilateral chromatic toe aberrations and discomfort. He had a history of hypertension and long-term tobacco smoking. The patient developed blue toes that progressed to necrotic black colouration, accompanied by pain and cold sensations. He had blue toe syndrome without any identified medical triggers. Physical examination and biopsy confirmed the diagnosis of CES, with cholesterol clefts observed in the affected artery. The patient experienced significant symptom improvement after 3 weeks. Skin biopsy of the blue toe to identify intra-arterial cholesterol clefts is useful for diagnosing CES.

Nefropatías vasculares: hipertensión vasculorrenal y nefropatía isquémica. Enfermedad tromboembólica y trombosis venosa renal

Vascular nephropathy is a term that covers the renal alterations associated with vascular pathology. One of the most representative entities is stenosis of the main renal artery, which often gives rise to secondary hypertension and a reduction in blood flow to the kidneys, leading to deterioration in their functioning. When this occurs it is denominated ischemic nephropathy. The most common aetiology for this is arteriosclerosis, although in young patients fibromuscular dysplasia is the most frequent cause. It should be diagnosed early, individualizing the imaging technique used depending on the degree of suspicion and the presence or not of kidney failure. Treatment should aim to control blood pressure as well as to preserve kidney functioning. Together with pharmacological treatment, angioplasty with or without placing a stent and surgical repair may be indicated in some cases.Thromboembolism of the main renal artery is a rare disease that mainly occurs in patients with a history of auricular fibrillation, and it may cause renal infarct. In atheroembolic kidney disease the small arteries of the kidneys are blocked by cholesterol crystals which have separated from atheroma plaques in the large arteries. It affects patients with severe arteriosclerosis and progresses with multisystem damage. Thrombosis of the renal vein is another rare pathology which affects patients with nephrotic syndrome more often.

Both hyperglycemia and hyperuricemia aggravate acute kidney injury during cholesterol embolism syndrome despite opposite effects on kidney infarct size

Kidney cholesterol crystal embolism (CCE) occurs in advanced atherosclerosis and induces a thrombotic (micro)angiopathy, a drop in the glomerular filtration rate (GFR), and an ischemic kidney infarction with necroinflammation. We speculated that common metabolic comorbidities such as diabetes or hyperuricemia would independently modulate each of these distinct pathophysiological processes. To test this, experimental CCE was induced by injecting cholesterol crystals into the left kidney artery of mice and thrombotic angiopathy, GFR drop, and infarct size were analyzed after 24 hours in the presence of hyperglycemia (about 500 mg/dL) or hyperuricemia (about 8 mg/dL) or their absence. In healthy mice, unilateral CCE caused diffuse thrombotic angiopathy in interlobar, arcuate and interlobular arteries, followed by a 50% or less drop in GFR compared to baseline and a variable degree of ischemic kidney necrosis. Hyperglycemia but not hyperuricemia aggravated thrombotic angiopathy although both caused a GFR decline, albeit via different mechanisms. Hyperglycemia aggravated GFR loss by increasing necroinflammation and infarct size, while the antioxidative effects of hyperuricemia reasonably attenuated necroinflammation and infarct size but induced a diffuse vasoconstriction in affected and unaffected kidney tissue. Thus, both hyperglycemia or hyperuricemia aggravate CCE-induced acute kidney failure despite having opposite effects on ischemic necroinflammation and infarction.

Systematic review of the relationship between Hollenhorst plaques and cerebrovascular events.

Few studies have evaluated the association between asymptomatic cholesterol emboli on fundoscopy (known as Hollenhorst plaque) and the subsequent risk of stroke or death.1. To evaluate the association between the presence of asymptomatic cholesterol retinal emboli and the risk of cerebrovascular events, with assessment of the need for carotid intervention. PubMed, Embase, and Cochrane Library databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines. Initial search revealed 43 in Medline and 46 in Embase databases. Twenty-four potentially eligible studies were included after duplicate and non-related studies were excluded based on title and abstract. Three more studies were identified from reference lists. Seventeen studies were included in the final analysis. Asymptomatic cholesterol emboli were present in 1343 patients. Approximately 17.8% (n = 181) had history of either cerebro-vascular Accident (CVA) or transient ischaemic attacks (TIAs) at presentation (more than 6 months). Nine studies mentioned the incidence of cerebrovascular events during follow-up. Of 780 patients, 93 evolved to stroke, TIAs, or death from a major carotid event during the follow-up period (6-86m), an incidence of about 12%. Death due to stroke was documented in 3 studies (n = 12). The presence of asymptomatic retinal emboli indicates a risk of a cerebrovascular event when compared to patients with no plaques seen on fundoscopy. The evidence suggests that these patients warrant referral for medical optimization of cardiovascular risk factors. Currently, there is no recommendation to support carotid endarterectomy in patients with Hollenhorst plaques, or retinal emboli, and further studies are needed to assess this.

AKI From Cholesterol Embolization Syndrome Treated With Corticosteroids

AKI From Cholesterol Embolization Syndrome Treated With Corticosteroids

S1941 Acute Pancreatitis Following a Lower Extremity Angioplasty

Introduction: Acute pancreatitis affects a significant population globally. Usual etiologies are gallstones, alcohol, hypertriglyceridemia, medications; less frequent are trauma, hypercalcemia, infections, toxins, ischemia, anatomic anomalies, vasculitis, and idiopathic. Pancreatitis post coronary intervention is an uncommon cause with only 19 published cases in the last two decades. Being cognizant of this etiology is important given the increasing number of patients undergoing angiography. Case Description/Methods: An 81-year-old female with hypertension, diabetes, peripheral arterial disease, prior cholecystectomy underwent left lower extremity angioplasty at an outside center. Within a few hours, she started having severe epigastric pain radiating to her back, nausea, vomiting and loose bloody stool. She presented to the emergency department 24 hours after symptom onset. Epigastric tenderness was present on exam. Labs revealed leukocytosis (24,450/µL),elevated lipase (1410 U/L), elevated creatinine (1.3 mg/dL), lactate (3.1 mmol/L), calcium 9.4 mg/dL and triglycerides 161 mg/dL. Incidentally, found to be positive for COVID-19. Normal common bile duct diameter seen on sonogram. CT angiogram of the abdomen/pelvis showed acute pancreatitis, duodenal and central small bowel enteritis (Figure). She was not on any medications known to cause pancreatitis and denied alcohol use. Patient improved with analgesics and intravenous fluids. She had no recurrence of bloody stools and hemoglobin remained stable. On day 4, she was able to tolerate a regular diet, and leukocyte count and creatinine normalized. Patient did not have any COVID respiratory symptoms, and was discharged. Discussion: Given the temporal association to angioplasty and no other identifiable cause, acute pancreatitis was presumed to be due to the contrast used during angioplasty. Other possibilities included cholesterol embolism but no peripheral signs of cholesterol embolism were seen. Patient was an asymptomatic COVID-19 case. Although, there are case series of pancreatitis due to COVID, those were found in very sick symptomatic patients. On review of literature, cholesterol embolism was identified as a definite cause only on autopsy or laparotomy (Table). Other possible mechanisms are: high viscosity of the contrast media leading to ischemia and necrosis, contrast causing NF-κB activation followed by epithelial damage, and vasospasm. Pancreatitis after coronary angiography is rare, nonetheless, an important differential especially if there is a temporal relationship.Figure 1.: CT scan (abdomen) of our patient demonstrating acute pancreatitis. Table 1. - Current literature reports on acute pancreatitis after coronary angiography/angioplasty S. NO. YEAR AUTHOR PROCEDURE ETIOLOGY TIME BETWEEN PROCEDURE AND SYMPTOM ONSET CONTRAST USED VOLUME OF CONTRAST(mL) 1 1994 Orvar et al1 Angiography Cholesterol emboli detected on autopsy 14 hours Not Mentioned 80-160 2 1994 Orvar et al1 Angiography Cholesterol emboli detected on autopsy Immediately Not Mentioned 80-160 3 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 4 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 5 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 6 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 7 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 8 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 9 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 10 1994 Orvar et al1 Angiography Contrast-Induced Not Mentioned Not Mentioned 80-160 11 1994 Orvar et al1 Angiography Cholesterol emboli detected on autopsy Not Mentioned Not Mentioned 80-160 12 1994 Orvar et al1 Angiography Cholesterol emboli detected on autopsy Not Mentioned Not Mentioned 80-160 13 2013 Gorges et al2 Angiography Contrast-Induced 1 hour Iopamidol 120 14 2014 Abstract 343, Journal of Hospital Medicine3 Angioplasty Contrast-Induced Not Mentioned Not Mentioned Not Mentioned 15 2017 Hajimaghsoudi et al4 Angiography Contrast-Induced 48 hours Visipaque(Iodixanol) 100 16 2020 Rafiq et al5 Angioplasty Contrast-Induced Immediately Ioversal 150 17 2020 Mui et al6 Angioplasty Contrast-Induced Immediately Omnipaque(Iohexol) 120 A total of 19 cases were identified. However, only seventeen cases have been shown in the table. Due to inability to get permission for reuse, the remaining 2 cases have not been shown. 1 - Orvar K, Johlin FC. Atheromatous embolization resulting in acute pancreatitis after cardiac catheterization and angiographic studies. Arch Intern Med 1994;154:1755–61 2 - Gorges R, Ghalayini W, Zughaib M. A case of contrast-induced pancreatitis following cardiac catheterization. J Invasive Cardiol 2013;25:E203–4. 3 - An Unusual Source of Abdominal Pain.Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev.. Abstract 343 Journal of Hospital Medicine, Volume 9, Suppl 2. https://shmabstracts.org/abstract/an-unusual-source-of-abdominal-pain/ 4 - Hajimaghsoudi M, Zeinali F, Mansouri M, et al. Acute necrotizing pancreatitis following coronary artery angiography: a case report. ARYA Atheroscler 2017;13:156–8. 5 - S1558 A Rare Case of Pancreatitis Secondary to Coronary Angiogram Dye. Rafiq, Rehan; Rafiq, Ahmad.The American Journal of Gastroenterology: October 2020 - Volume 115 - Issue - p S791doi: 10.14309/01.ajg.0000708280.94586.25 6 - Mui JJ, Shamavonian R, Thien KCP. Acute pancreatitis following coronary angiography: case report and review of contrast-induced pancreatitis. Int Surg J 2020;7:870-2

The systemic immune response due to cholesterol crystal embolization syndrome: a case report

BackgroundCholesterol crystal embolization syndrome (CES) occurs when an atherosclerotic plaque causes small-vessel embolization, resulting in multi-organ damage. Although CES is pathologically characterized by an infiltration of eosinophils, the implication of the systemic inflammatory response represented by hypereosinophilia is unclear in clinical practice. Herein we present the case of a patient diagnosed with CES who developed multiple allergic organ injuries, including daptomycin-related dermatitis and later vancomycin-induced acute tubulointerstitial nephritis, which was successfully treated by the withdrawal of each medicine with or without corticosteroid therapy, one by one.Case presentationA 76-year-old Japanese man diagnosed with thoracic aneurysm rupture underwent total arch replacement through the open stent graft technique. Postoperatively, he developed methicillin-resistant Staphylococcus epidermidis bacteremia, which was treated with daptomycin. Subsequently, he presented with palpable purpura on both dorsal feet, erythema around his body, and hypereosinophilia. Daptomycin was replaced with vancomycin due to suspicion of drug-induced erythema. The erythema gradually faded. On nine days after vancomycin therapy, the systemic erythema rapidly reappeared followed by acute renal failure. The renal function decline prompted hemodialysis. A skin biopsy revealed cholesterol embolization, whereas a kidney biopsy revealed acute tubulointerstitial nephritis. After vancomycin discontinuation and initiation of systemic corticosteroid treatment, his kidney function was restored to the baseline level.ConclusionsThe present case highlights cholesterol embolization can cause allergic complications in addition to direct organ damage.

Abstract 275: The Association Between Elevated Lipoprotein(a) And In-hospital Outcomes

Purpose: Elevated lipoprotein(a), Lpa, has quickly emerged as an independent cardiovascular disease risk factor with increased risk for adverse atherosclerotic Using the National Inpatient Sample (NIS) database, we sought to assess the association of elevated Lp(a) to in-hospital cardiovascular outcomes. Methods: We identified patients with elevated Lpa using ICD-10 code in the NIS data from the year 2019. We compared in-hospital outcomes between elevated and non-elevated Lpa groups before and after propensity score matching. We then performed a regression analysis on the matched cohort. Our predictors of interest were acute myocardial infarction (AMI), cerebrovascular disease (CEVD), peripheral vascular disease (PVD), and a composite outcome (cardiorisk) including, AMI, CEVD, and PVD. Results: In the unmatched cohort, the elevated Lpa group had higher incidences of AMI, CEVD, PVD, and the composite outcome (all p<0.05). However, length of stay and cost of hospitalization did not differ considerably. After propensity score matching, the elevated Lpa group had higher rates of AMI (7.1% vs 1.2%, p<0.001), CEVD (11.2% vs 2.8%, p<0.001), PVD (1.8% vs 0.2%, p=0.021), and composite outcome (20% vs 6%, p<0.01). Elevated Lpa group had longer length of stay 5±5 vs 4±3, p=0.002), and higher cost of hospitalization (69,060 ± 76,028 vs 20,992±15,065, p<0.001). Multivariable regression analysis controlling for common predictors of atheroembolic risk showed higher odds of AMI (2.33, p<0.001), CEVD (1.62, p= 0.002), PVD (2.22, p=0.094), and cardiorisk (1.68, p<0.001) among the elevated Lpa group. Conclusion: Elevated Lpa is associated with a higher incidence of atheroembolic disease in this nationally representative sample and associated with a higher length of stay and healthcare costs. Further research is needed to fully understand its mechanism and possible treatment to reduce adverse cardiovascular outcomes.

Outcomes of patients with Cholesterol crystal embolism treated by peritoneal dialysis: retrospective study from the RDPLF registry.

Cholesterol crystal embolisms disease (CED) is a systemic disease characterized by tissue ischemia and microinflammation related to occlusion of arterioles by microemboli from ulcerated atheromatous plaques. The kidney is one of the most affected organs, often requiring dialysis. Our study examines the outcomes of a cohort of patients with CED treated with peritoneal dialysis (PD). As anticoagulants can favor emboli, peritoneal dialysis may theoretically have an advantage.
 From the database of the French Language Peritoneal Dialysis Registry (RDPLF), between January 1, 1995, and December 31, 2021, we selected patients treated with PD for >90 days and with an age >18 years. On the basis of the variables of patient autonomy, diabetes, BMI, modified Charlson index, age, sex, pre-PD treatment, causes of death, causes of transfer to hemodialysis, and peritonitis, three types of survival were estimated (patient, technical, and composite). After adjustment by propensity scores and taking into account competitive risks, 2 groups of patients were constituted on the basis of baseline nephropathy: emboli group vs. control group.
 Patient survival and strict technical survival are not associated with the type of nephropathy (CED versus others). Composite technical survival (uncensored for deaths and transfers to hemodialysis) was only associated with cholesterol emboli nephropathy in the multivariate analysis adjusted for diabetes, autonomy, and age of the patient at the start of the dialysis treatment (p=0.011; 95% CI [0.736 [0.581-0.931]]).
 Our study from the RDPLF database shows no difference in technical and patient survival in a cohort of patients with CED vs. a control group. It also confirms that PD may represent an adequate choice in this pathology.

Fundus autofluorescence in detection of embolus in retinal artery occlusion

Fundus autofluorescence (FAF) is a noninvasive imaging tool helpful in various retinal and choroidal diseases. In this series, we report the utility of FAF in two cases of retinal artery occlusion (RAO). Cholesterol embolus was seen as a bright hyper autofluorescent foci on FAF in a case of branch RAO. Platelet fibrin embolus exhibited minimal hyper autofluorescence in another case of multiple RAO in contrast to bright hyper autofluorescence of cholesterol embolus. Fundus autofluorescence may be helpful in easier identification of cholesterol embolus in RAO and helps in differentiating it from platelet fibrin embolus.

A case of cholesterol embolism after superselective intra-arterial chemotherapy for oral-floor carcinoma

A case of cholesterol embolism after superselective intra-arterial chemotherapy for oral-floor carcinoma

Cutaneous manifestations of acute kidney injury.

ABSTRACTAcute kidney injury (AKI) is a common medical problem with a multitude of aetiologies. Prompt diagnosis and management is key in the prevention of complications. Cutaneous signs can often give diagnostic clues of underlying systemic diseases causing AKI. This review summarizes cutaneous findings of diseases causing AKI in adults. Knowledge of such cutaneous signs could lead to earlier diagnosis of underlying kidney disease and facilitate management strategies in a timely manner. Acute interstitial nephritis, polyarteritis nodosa, Kawasaki's disease, granulomatosis with polyangiitis (previously Wegener's granulomatosis), microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (previously Churg–Strauss syndrome), Henoch–Schönlein purpura, cryoglobulinaemia, Sjögren's syndrome, systemic sclerosis, nephrogenic systemic fibrosis, dermatomyositis, systemic lupus erythematosus, amyloidosis and cholesterol embolization syndrome were highlighted as diseases causing AKI with cutaneous manifestations.