Atheroembolic renal disease

Atheroembolic renal disease is an important and often underdiagnosed cause of renal insufficiency in the elderly. Renal damage results from embolization of cholesterol crystals from atherosclerotic plaques in large vessels such as the abdominal aorta to small arteries of the kidney. The typical patient is a white man older than 60 years who has an insidious increase in serum creatinine levels after an arteriographic procedure or vascular surgery. Renal outcome ranges from partial recovery of kidney function to end stage renal disease requiring replacement therapy. Tissue injury from cholesterol crystal embolization is not restricted to the kidneys but also involves the skin, muscles, abdominal organs, and central nervous system resulting in significant morbidity and mortality. Accurate diagnosis is often made by performing a skin, muscle, or renal biopsy. Although effective therapy is lacking, heightened awareness of atheroembolic renal disease is necessary for prompt diagnosis and institution of supportive care.