Recurrent Acute Kidney Injury Due to Atheroembolic Renal Disease: Diagnostic Utility of Fundoscopy

Atheroembolic renal disease (AERD) is a rare and often underdiagnosed cause of acute kidney injury (AKI), particularly in patients with atherosclerotic disease. We present the case of a 66-year-old man with hypertension, hyperlipidemia, and stage 3 chronic kidney disease (CKD) (baseline creatinine 100-120 μmol/L) who developed AKI after coronary artery bypass graft (CABG) for non-ST-elevation myocardial infarction (NSTEMI), followed by recurrent episodes and progressive renal decline despite no further invasive procedures. Fundoscopic examination revealed Hollenhorst plaques, leading to a clinical diagnosis of AERD. This case underscores the diagnostic value of noninvasive ophthalmologic evaluation in patients at high risk for cholesterol embolism. The patient was managed with supportive measures, including hydration and blood pressure control, which helped stabilize renal function (creatinine improved from 591 to 410 μmol/L). Our objective is to highlight the diagnostic utility of fundoscopy in evaluating unexplained renal deterioration and systemic ischemic symptoms in frail patients where biopsy is contraindicated.