The challenge of diagnosing atheroembolic renal disease : Clinical features and prognostic factors

• Published in: Circulation (New York, N.Y.) Vol. 116; no. 3; pp. 298 - 304
• Main Authors: SCOLARI, Francesco, RAVANI, Pietro, BONARDELLI, Stefano, FAGGIANO, Pompilio, BARRETT, Brendan J, GAGGI, Rossella, SANTOSTEFANO, Marisa, ROLLINO, Cristiana, NEVIO, Stabellini, LOREDANA, Colla, BATTISTA FABIO, Viola, PAOLO, Maiorca, VENTURELLI, Chiara
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 17.07.2007
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Embolism, Cholesterol - diagnosis; Embolism, Cholesterol - mortality; Embolism, Cholesterol - pathology; Female; Follow-Up Studies; Glomerulonephritis; Heart; Humans; Kidney Diseases - diagnosis; Kidney Diseases - mortality; Kidney Diseases - pathology; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prognosis; Prospective Studies; Retrospective Studies; Endocrinopathy; Kidney disease; Urinary system disease; Prognosis; Catheterization; Diabetes mellitus; Lipids; Cardiovascular disease; Anticoagulant; Cholesterol; peripheral vascular disease; Vascular disease; Nephropathy; Atherosclerosis; anticoagulants; fibrillation
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.680991

Atheroembolic renal disease (AERD) is caused by showers of cholesterol crystals released by eroded atherosclerotic plaques. Embolization may occur spontaneously or after angiographic/surgical procedures. We sought to determine clinical features and prognostic factors of AERD. Incident cases of AERD were enrolled at multiple sites and followed up from diagnosis until dialysis and death. Diagnosis was based on clinical suspicion, confirmed by histology or ophthalmoscopy for all spontaneous forms and for most iatrogenic cases. Cox regression was used to model time to dialysis and death as a function of baseline characteristics, AERD presentation (acute/subacute versus chronic renal function decline), and extrarenal manifestations. Three hundred fifty-four subjects were followed up for an average of 2 years. They tended to be male (83%) and elderly (60% >70 years) and to have cardiovascular diseases (90%) and abnormal renal function at baseline (83%). AERD occurred spontaneously in 23.5% of the cases. During the study, 116 patients required dialysis, and 102 died. Baseline comorbidities, ie, reduced renal function, presence of diabetes, history of heart failure, acute/subacute presentation, and gastrointestinal tract involvement, were significant predictors of event occurrence. The risk of dialysis and death was 50% lower among those receiving statins. Clinical features of AERD are identifiable. These make diagnosis possible in most cases. Prognosis is influenced by disease type and severity.