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The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors
Francesco Scolari1, Pietro Ravani, Rossella Gaggi
1Division of Nephrology, University and Spedali Civili, Brescia, Italy. fscolar@tin.it
Insights
Atheroembolic renal disease (AERD) affects elderly males with cardiovascular issues. Prognosis depends on disease severity, but statin use may reduce the risk of dialysis and death.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pathology
Background:
- Atheroembolic renal disease (AERD) results from cholesterol crystal emboli from atherosclerotic plaques.
- Embolization can be spontaneous or procedure-related, impacting renal function.
Purpose of the Study:
- To identify clinical features of AERD.
- To determine prognostic factors influencing outcomes in AERD patients.
Main Methods:
- Prospective enrollment of incident AERD cases across multiple sites.
- Diagnosis confirmed by histology or ophthalmoscopy.
- Cox regression analysis to model time to dialysis and death.
Main Results:
- 354 elderly male patients with cardiovascular disease and baseline renal dysfunction were followed for 2 years.
- 23.5% of AERD cases were spontaneous.
- Reduced renal function, diabetes, heart failure, acute presentation, and GI involvement predicted adverse events; statin use was associated with a 50% lower risk of dialysis and death.
Conclusions:
- Clinical features of AERD are identifiable, aiding diagnosis.
- Prognosis is significantly influenced by disease type, severity, and baseline comorbidities.
- Early identification and management may improve patient outcomes.
Background:
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.
Methods And Results:
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.
Conclusions:
Clinical features of AERD are identifiable. These make diagnosis possible in most cases. Prognosis is influenced by disease type and severity.
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