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Eosinophilia as a Clue to the Diagnosis of Atheroembolic Renal Disease

Eosinophilia as a Clue to the Diagnosis of Atheroembolic Renal Disease Abstract Cholesterol embolization to the kidney is a common occurrence, according to the results that have been reported in autopsy studies, in which renal cholesterol emboli were seen in 15% to 30% of patients with severe atherosclerosis of abdominal aorta.1 Cholesterol emboli to the kidney occur with significant frequency following aortic surgery or invasive vascular angiographic studies.1,2 An unknown proportion of these patients show clinical manifestations, predominantly as acute renal failure. Atheroembolism to the kidney is diagnosed correctly ante mortem in only a few of these patients. The diagnosis of atheroembolic renal disease is difficult to make because of lack of any characteristic findings in the usual tests of renal function or urinalysis. Physical examination is helpful only if livedo reticularis of the lower extremities, digital infarcts, or retinal cholesterol emboli are present, but these features may not be consistently present. The clinical setting in which this disease occurs References 1. Thurlbeck W, Castleman B: Atheromatous emboli to the kidneys after aortic surgery. N Engl J Med 1957;257:442-447.Crossref 2. Ramirez G, O'Neill Jr W, Lambert R, et al: Cholesterol embolization: A complication of angiography. Arch Intern Med 1978;138:1430-1432.Crossref 3. Kasinath BS, Corwin HL, Bidani AK, et al: Eosinophilia in the diagnosis of atheroembolic renal disease. Am J Nephrol , in press. 4. Carvajal J, Anderson W, Weiss L, et al: Atheroembolism. Arch Intern Med 1967;119:593-599.Crossref 5. Smith M, Ghose M, Henry A: The clinical spectrum of renal cholesterol embolization. Am J Med 1981;71:174-180.Crossref 6. Cosio F, Zager R, Sharma H: Atheroembolic renal disease causes hypocomplementemia. Lancet 1985;2:118-121.Crossref 7. MacDonnell Richards A, Eliot R, Kanjuh V, et al: Cholesterol embolism: A multi-system disease masquerading as polyarteritis nodosa. Am J Cardiol 1965;15:696-707.Crossref 8. Fang L, Sirota R, Ebert T, et al: Low fractional excretion of sodium with contrast media—induced acute renal failure. Arch Intern Med 1980;140:531-533.Crossref 9. Gonsette R, Delmotte P: In vitro activation of serum complement by contrast media: A clinical study. Invest Radiol 1980;15 ( (suppl) ):26-28.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Eosinophilia as a Clue to the Diagnosis of Atheroembolic Renal Disease

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References (10)

Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1987.00370080020004
Publisher site
See Article on Publisher Site

Abstract

Abstract Cholesterol embolization to the kidney is a common occurrence, according to the results that have been reported in autopsy studies, in which renal cholesterol emboli were seen in 15% to 30% of patients with severe atherosclerosis of abdominal aorta.1 Cholesterol emboli to the kidney occur with significant frequency following aortic surgery or invasive vascular angiographic studies.1,2 An unknown proportion of these patients show clinical manifestations, predominantly as acute renal failure. Atheroembolism to the kidney is diagnosed correctly ante mortem in only a few of these patients. The diagnosis of atheroembolic renal disease is difficult to make because of lack of any characteristic findings in the usual tests of renal function or urinalysis. Physical examination is helpful only if livedo reticularis of the lower extremities, digital infarcts, or retinal cholesterol emboli are present, but these features may not be consistently present. The clinical setting in which this disease occurs References 1. Thurlbeck W, Castleman B: Atheromatous emboli to the kidneys after aortic surgery. N Engl J Med 1957;257:442-447.Crossref 2. Ramirez G, O'Neill Jr W, Lambert R, et al: Cholesterol embolization: A complication of angiography. Arch Intern Med 1978;138:1430-1432.Crossref 3. Kasinath BS, Corwin HL, Bidani AK, et al: Eosinophilia in the diagnosis of atheroembolic renal disease. Am J Nephrol , in press. 4. Carvajal J, Anderson W, Weiss L, et al: Atheroembolism. Arch Intern Med 1967;119:593-599.Crossref 5. Smith M, Ghose M, Henry A: The clinical spectrum of renal cholesterol embolization. Am J Med 1981;71:174-180.Crossref 6. Cosio F, Zager R, Sharma H: Atheroembolic renal disease causes hypocomplementemia. Lancet 1985;2:118-121.Crossref 7. MacDonnell Richards A, Eliot R, Kanjuh V, et al: Cholesterol embolism: A multi-system disease masquerading as polyarteritis nodosa. Am J Cardiol 1965;15:696-707.Crossref 8. Fang L, Sirota R, Ebert T, et al: Low fractional excretion of sodium with contrast media—induced acute renal failure. Arch Intern Med 1980;140:531-533.Crossref 9. Gonsette R, Delmotte P: In vitro activation of serum complement by contrast media: A clinical study. Invest Radiol 1980;15 ( (suppl) ):26-28.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 1, 1987

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