Atheroembolic Renal Failure
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Contents |
Etiology
- idiopathic (spontaneous)
- after an invasive procedure
Epidemiology
- older patients
- often a history of smoking
Pathology
- cholesterol emboli in medium-sized arteries
- biconcave crystalline clefts
- intense tubulointerstitial nephritis
Clinical-manifestations
- livedo reticularis of the extremities
- emboli seen on fundoscopic examination
- other organ system dysfunction may occur concurrently
- ARF after 24 hr (slower onset than ARF secondary to radiographic contrast media)
Laboratory
- rule/out alternative diagnosis
- high erythrocyte sedimentation rate (ESR)
- CH50: low level of complement
- complete blood count ( CBC)
- eosinophils in the urine -> AIN
- biopsy of muscle, skin or kidney (see cholesterol embolism)
Differential-diagnosis
Management
- correct the source of embolization
- anticoagulation may aggravate the tendency for embolization
- treatment of hypertension
- dialysis may be necessary
- prognosis: generally minimally reversible renal failure
More General Terms
Additional Terms
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 599
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
