Reversal of Gangrenous Lesions in the Blue Toe Syndrome with Lovastatin A Case Report

Cabili, S; Hochman, Israel; Goor, Yoav

doi:10.1177/000331979304401010

Cited by 49 publications

(16 citation statements)

References 18 publications

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“…To date, the role of statins in AERD remains uncertain, because only occasional cases have responded to lovastatin and simvastatin (11,12). Because deterioration in renal function over several weeks observed in the majority of patients with AERD suggests an ongoing embolic process, strategies should be developed to stabilize ulcerated atherosclerotic plaques showering cholesterol emboli into renal circulation.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Scolari¹,

Ravani

Pola³

et al. 2003

Journal of the American Society of Nephrology

125

150

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Abstract. Atheroembolic renal disease (AERD) is part of a multisystemic disease accompanied by high cardiovascular comorbidity and mortality. Interrelationships between traditional risk factors for atherosclerosis, vascular comorbidities, precipitating factors, and markers of clinical severity of the disease in determining outcome remain poorly understood. Patients with AERD presenting to a single center between 1996 and 2002 were followed-up with prospective collection of clinical and biochemical data. The major outcomes included end-stage renal disease (ESRD) and death. Ninety-five patients were identified (81 male). AERD was iatrogenic in 87%. Mean age was 71.4 yr. Twenty-three patients (24%) developed ESRD; 36 patients (37.9%) died. Cox regression analysis showed that significant independent predictors of ESRD were long-standing hypertension (hazard ratio [HR] ϭ 1.1; P Ͻ 0.001) and preexisting chronic renal impairment (HR ϭ 2.12; P ϭ 0.02); use of statins was independently associated with decreased risk of ESRD (HR ϭ 0.02; P ϭ 0.003). Age (HR ϭ 1.09; P ϭ 0.009), diabetes (HR ϭ 2.55; P ϭ 0.034), and ESRD (HR ϭ 2.21; P ϭ 0.029) were independent risk factors for patient mortality; male gender was independently associated with decreased risk of death (HR ϭ 0.27; P ϭ 0.007). Cardiovascular comorbidities, precipitating factors, and clinical severity of AERD had no prognostic impact on renal and patient survival. It is concluded that AERD has a strong clinical impact on patient and renal survival. The study clearly shows the importance of preexisting chronic renal impairment in determining both renal and patient outcome, this latter being mediated by the development of ESRD. The protective effect of statins on the development of ESRD should be evaluated in a prospective study.AERD is part of a multisystemic disease caused by showers of cholesterol emboli from atherosclerotic aorta to many organs. It may occur spontaneously or more often as a complication of major medical or surgical procedures. The disease is usually associated with poor renal and patient survival. In the last decade, some clinical studies have increased our understanding of AERD, enabling us to make premortem diagnosis. The presence of a triad characterized by a precipitating event, subacute renal failure, and peripheral cholesterol embolization strongly suggests the diagnosis, which can be confirmed by the biopsy of the target organs (1-6).Although the clinical features of the AERD have been well delineated, the predictors of the outcomes of the disease have never been studied in a large population of patients. In addition to the traditional risk factors for atherosclerosis, other factors may be associated with the outcomes, including comorbidities, precipitating factors, and clinical severity of the disease. However, the different and relative contribution of each factor is unknown. In the present study, we prospectively followed up 95 consecutive patients with diagnosis of AERD to gain insight into the interrelationship of potential predictors ...

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Section: Discussionmentioning

confidence: 99%

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Scolari¹,

Ravani

Pola³

et al. 2003

Journal of the American Society of Nephrology

125

150

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“…Sabe-se que estabilizam as placas de colesterol, mas não há uma indicação absoluta no tratamento desta condição 23 24 . O fato da deterioração da função renal se dar por semanas, como observado na maioria dos pacientes com DRAE, sugere a presença de um processo embólico contínuo.…”

Section: Discussionunclassified

Doença renal ateroembólica: uma causa de insuficiência renal aguda pouco explorada

Dummer¹,

Veronese²,

Piana³

2010

Rev. Assoc. Med. Bras.

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ResumoO ateroembolismo é uma doença multisistêmica que afeta vários órgãos, entre os quais o rim, através da liberação de êmbolos de colesterol de uma placa aterosclerótica erosada, ocasionando obstrução vascular em diversos tecidos. A doença renal ateroembólica (DRAE), histologicamente representada por cristais de colesterol nas arteríolas do rim acompanhados de um infiltrado inflamatório perivascular, é causa de insuficiência renal aguda muitas vezes grave e prolongada, que ocorre semanas ou mesmo meses após o episódio embólico. A DRAE apresesenta prognóstico ruim com elevada mortalidade. Apresentamos neste relato o caso de um paciente com DRAE que se manifestou clinicamente dois meses após a realização de um cateterismo cardíaco seguido de uma angioplastia coronária. A prevalência, manifestações clínicas, histologia renal, tratamento e o prognóstico da DRAE são discutidos. unitermos: Embolia de colesterol. Cateterismo cardíaco. Insuficiência renal aguda. intRoduçãoO ateroembolismo é uma doença multisistêmica, afetando diversos órgãos como pele, rins, trato gastrointestinal e sistema nervoso central. Em 25% dos casos podem ocorrer de forma espontânea, mas na maiora das vezes é uma complicação de procedimentos endovasculares e/ou terapia anticoagulante ou trombolítica, quando êmbolos de colesterol deslocam-se de uma placa aterosclerótica erosada de uma grande artéria (em geral a aorta) e ocluem pequenas artérias e arteríolas em diferentes órgãos, ocasionando infarto isquêmico. A doença renal ateroembólica (DRAE) pode ser definida como uma insuficiência renal secundária à oclusão das artérias e arteríolas renais por êmbolos de colesterol que se depositam na forma de cristais [1][2][3][4][5] . A incidência exata da DRAE não é conhecida, pois muitos casos não são diagnosticados ou são identificados post-mortem 1,2 . A sua apresentação clínica é variável, desde um quadro subclínico até uma doença fatal. O método diagnóstico mais acurado é a biópsia renal, que mostra cristais de colesterol ocluindo artérias interlobulares e arteríolas, acompanhados de infiltrado inflamatório mononuclear e eosinofílico 1,2,5 . A DRAE é uma complicação devastadora da doença aterosclerótica, e até o momento não tem um tratamento que seja específico e eficaz 1,2, 6-8 . casoPaciente de 54 anos, branco, do sexo masculino, 83 kg, admitido no hospital com quadro de síndrome coronariana aguda (SCA) e supradesnível no segmento ST, sugerindo infarto inferior. Foi submetido à terapia trombolítica com estreptoquinase. Contudo, não houve sinais clínicos e eletrocardiográficos de reperfusão.Na admissão, o paciente apresentava creatinina sérica de 0,9 mg/dl e uma filtração glomerular estimada de 70,3 ml/minuto. Realizou cateterismo cardíaco no dia seguinte à identificação de uma lesão severa na coronária descendente anterior (ADA) e oclusão proximal da coronária direita (ACD). Foi então submetido à angioplastia coronária e colocação de stent na ADA. Devido a dificuldades técnicas não foi possível ultrapassar a lesão da ACD, e duas semanas após foi ...

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“…Specific treatments remain to be established, with the prognosis being poor. 1 Cholesterol-lowering drugs 22 and glucocorticoids 23,24 have been reported to be effective in improving the clinical symptoms of CCE, although there is disagreement regarding these treatments. Hasegawa et al 25 reported that combined therapy with steroid and plasma exchange was effective in patients with renal failure and CCE, while Belenfant et al 26 demonstrated that aggressive supportive treatment incorporating control of hypertension and heart failure, dialytic therapy, and adequate nutrition was associated with a significant improvement in survival rate.…”

Section: Discussionmentioning

confidence: 99%

Severe hyperreninemic hypertension associated with spontaneous renal cholesterol crystal embolization

et al. 2004

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A 70-year-old man was admitted because of severe hypertension and renal insufficiency. Marked elevation in plasma renin activity (PRA; 34.2 ng/ml per h) was noted. Five days later, the patient developed hemorrhagic duodenal ulcers and panperitonitis, went into shock, and died. An autopsy revealed severe atherosclerosis with marked ulceration in the abdominal aorta. Renal histology showed multiple cholesterol crystal embolization (CCE) associated with infarction. Cholesterol crystals were also detected in the vessels of the gastrointestinal system, including the liver, stomach, colon, and pancreas. Although not common, spontaneous CCE should be considered in elderly patients who present with abrupt onset of severe hypertension associated with renal insufficiency. The most important finding in this patient was severe hyperreninemia. Although potentiation of the renin-angiotensin-aldosterone system is the suggested mechanism for the hypertension in renal CCE, we could not find any reported case of renal CCE with hyperreninemia. It is reasonable to consider that severe hyperreninemia might be overlooked in renal CCE. PRA should be measured in patients with renal CCE, because it may give important information for selecting antihypertensive agents and improving the prognosis. To clarify this possibility, an accumulation of similar cases is necessary.

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Reversal of Gangrenous Lesions in the Blue Toe Syndrome with Lovastatin A Case Report

Cited by 49 publications

References 18 publications

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Predictors of Renal and Patient Outcomes in Atheroembolic Renal Disease

Doença renal ateroembólica: uma causa de insuficiência renal aguda pouco explorada

Severe hyperreninemic hypertension associated with spontaneous renal cholesterol crystal embolization

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