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Recovery from hemodialysis therapy in a patient with renal cholesterol crystal embolism

Akihiko Kato1, Akiko Ohtsuji, Tatsuhiro Terada

  • 1First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. a.kato@scchr.jp

Nephron
|August 21, 2002
PubMed

Insights

Renal cholesterol crystal embolism (CCE) often leads to chronic kidney disease. Surgical amputation of affected toes rapidly improved renal function and resolved inflammation in one patient, suggesting inflammation reversal is key.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Dermatology

Background:

  • Renal cholesterol crystal embolism (CCE) carries a poor prognosis, frequently progressing to end-stage renal disease.
  • Patients often present with symptoms like digital cyanosis and livedo reticularis following procedures like aortic angiography.

Observation:

  • A 66-year-old male with CCE developed acute kidney injury requiring hemodialysis (HD).
  • He presented with painful digital cyanosis, livedo reticularis, eosinophilia, and proteinuria (3.0 g/day).
  • Serum creatinine rose from 2.18 to 8.57 mg/dL over six weeks, necessitating HD initiation.

Findings:

  • Despite simvastatin treatment, renal function and hypereosinophilia persisted.
  • Amputation of gangrenous toes led to immediate improvement in urine output and complete resolution of eosinophilia.
  • C-reactive protein levels decreased significantly, and serum creatinine dropped to 3.46 mg/dL, allowing cessation of HD after 32 sessions.

Implications:

  • This case highlights the potential for surgical intervention to rapidly restore renal function in CCE.
  • Prompt reversal of systemic inflammation, achieved through amputation, may be more critical than lipid-lowering therapy for managing CCE-induced renal failure.
  • Early and aggressive management of the inflammatory source is crucial for improving outcomes in patients with renal cholesterol crystal embolism.

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