Atheroembolic Kidney Disease

Atheroembolic renal disease (AERD), also known as cholesterol atheroembolic renal disease, atheroembolism, cholesterol embolism, or cholesterol crystal embolization, is often an underdiagnosed clinical illness. AERD is often a diagnosis of exclusion as definitive findings are rare, and clinical history often overlaps with many other conditions. However, the incidence is increasing with the increasing use of catheter-based treatment approaches and increased prevalence of risk factors. A clinical triad of an inciting event, acute or subacute renal injury, and skin findings should raise suspicion for AERD.

Cholesterol emboli are an important cause of renal impairment. Irregularly shaped atheroemboli can cause partial or complete obstruction of small renal vessels, resulting in ischemia. A vasculitis-like picture is commonly seen with an inflammatory reaction and, ultimately, giant cell formation. The relation of these emboli may be temporally found to the use of anticoagulants, vascular manipulation, or thrombolytic drug use. However, spontaneous cases have also been reported. Patients who develop atheroembolic renal disease may present with a spectrum of clinical presentations of acute renal failure ranging from mild or asymptomatic to life-threatening conditions.

Atheroembolic renal disease is caused by the occlusion of the small renal arteries by cholesterol crystal emboli from ulcerated atherosclerotic plaques and is a part of systemic atheroembolism disease. The proximity of the kidneys to the abdominal aorta and high renal blood flow makes them a frequent target of cholesterol emboli. Results from one autopsy study revealed that 74% of cases with cholesterol atheroembolic disease involved the kidneys.