Cholesterol crystal embolization induced kidney disease

Cholesterol crystal embolization (CCE) results from the release of cholesterol crystals from ruptured atherosclerotic plaques into circulation, resulting in the occlusion of small arteries and arterioles in various organs. Ischemia triggers a systemic inflammatory response resulting in vascular obstruction and organ dysfunction. Kidneys are often involved because of the proximity to the aorta and CCE in the kidneys can result in acute, sub-acute, or chronic kidney disease. There are many known risk factors for renal involvement of CCE, including iatrogenic and spontaneous causes. The pathophysiology of CCE includes complex pathways that lead to acute and chronic effects that can have direct deleterious effects on the kidney. The diagnosis entails numerous lab studies and potential need for tissue biopsy. Treatment is often supportive but can also include more novel therapies. This paper reviews the pathophysiology, clinical manifestations, diagnostic approaches, and management strategies for CCE affecting the kidneys.