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Renal failure due to cholesterol embolization following percutaneous transluminal renal angioplasty
1Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Insights
Cholesterol embolization syndrome can occur after renal angioplasty, leading to kidney failure. Careful patient selection is crucial for renovascular hypertension treatment.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pathology
Background:
- Renovascular hypertension poses significant risks, especially in patients with compromised renal function.
- Diffuse atherosclerosis and diabetes mellitus are common comorbidities that increase procedural risks.
- Solitary functioning kidney necessitates meticulous management to preserve renal function.
Observation:
- A 63-year-old diabetic woman with renovascular hypertension and a solitary functioning kidney underwent successful renal angioplasty.
- Post-procedure, the patient developed fever, myalgia, and progressive elevations in blood urea nitrogen and creatinine.
- Within a month, the patient became uremic, requiring dialysis, and passed away six months later.
Findings:
- Autopsy confirmed cholesterol crystal embolization in the kidneys, pancreas, and spleen.
- Cholesterol embolization syndrome was identified as the cause of subacute renal failure.
- The findings highlight a rare but severe complication of percutaneous transluminal renal angioplasty.
Implications:
- This case underscores the critical need for thorough patient assessment before renal angioplasty in high-risk individuals.
- Minimizing procedural trauma and considering alternative treatments may be warranted for patients with solitary kidneys.
- Enhanced vigilance for cholesterol embolization syndrome post-procedure is essential for early diagnosis and management.
Abstract:
Percutaneous transluminal renal angioplasty was performed in a 63-year-old diabetic woman who had renovascular hypertension with solitary functioning kidney and diffuse atherosclerosis. Angioplasty was technically successful, while thereafter, fever and myalgia of legs occurred with gradual increases in blood urea nitrogen and creatinine. The patient became uremic over a month after angioplasty and was placed on dialysis. She died six months after angioplasty. Autopsy revealed cholesterol embolization in bilateral kidney, pancreas and spleen, causing subacute renal failure. It is suggested that careful assessment of the patient should be made when determining the need for renal angioplasty for renovascular hypertension with a solitary functioning kidney.