The Evaluation of Corticosteroid Therapy in Conjunction with Plasma Exchange in the Treatment of Renal Cholesterol Embolic Disease

Hasegawa, Midori; Kawashima, Shirou; Shikano, Masahiko; Hasegawa, Hiroshi; Tomita, Makoto; Murakami, Kazutaka; Kushimoto, Hiroko; Katsumata, Hideki; Toba, Takako; Oohashi, Atsushi; Hiramitsu, Shinya; Matsunaga, Kayoko

doi:10.1159/000013598

Cited by 32 publications

(24 citation statements)

References 18 publications

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“…In previous reports, tapering or withdrawal of corticosteroids resulted in the progression of disease, and increasing the dose or resuming the drug was required (19,21,22). Therefore, we slowly tapered the corticosteroids at a rate of 5 mg at an interval of approximately four weeks following confirmation of the absence of a worsening renal function and re-elevation of eosinophils.…”

Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

et al. 2013

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Cholesterol crystal embolism (CCE) is a serious complication associated with invasive vascular procedures. The prognosis of the renal involvement type of CCE is very poor, and there is currently no established treatment, other than supportive therapy. We herein report four cases of CCE with severe atherosclerosis wherein the renal function progressively deteriorated after cardiac catheterization. In three of the four patients, lowdose corticosteroids (0.3 mg/kg/day) improved the renal function, whereas the fourth patient died from CCE of the digestive system. This report reviews the literature on CCE and discusses possible therapeutic options.

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Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

et al. 2013

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“…Aynı zamanda asetil salisilik asit ve statin tedavisine devam ettik. Eozinofilinin eşlik ettiği bazı olgularda kortikosteroid tedavisinin etkili olduğu bildirilmiştir (22,23). Biz de olgumuza 10 gün süreyle 1mg/kg dozunda metilprednizolon tedavisi uyguladık.…”

Section: Discussionunclassified

Cholesterol Crystal Embolism Following Coronary Angiography: A Case Report

Demir¹,

Yürüyen²,

Müderrisoğlu³

et al. 2013

Istanbul Med J

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Kolesterol kristal embolisisi sendromu (KES) günümüzde damar içi girişimlerin ve trombolitik ajanlar, heparin gibi tedavilerin sık kullanılmasıyla beraber sıklığı artan ve son dönem böbrek yetmezliklerinin %3'ten fazlası-nın etyolojisinde yer alabilen bir sendromdur. Diyabetik, hipertansif, sigara kullanan erkek hastalarda daha çok görülür. Temel patogenez damar içi girişimlerden sonra yerinden oynayan ve distal arteryel dolaşıma katılan kolesterol kristallerinin endarterlerde yaptığı inflamatuar ve obliteratif prosestir. Sık etkilenen organların da böbrek, cilt, gastrointestinal sistem, ekstremiteler, olduğu düşünülürse klinikte kötüleşen hipertansiyon, ciltte purpura, ekimoz, karın ağrısı, kilo kaybı, böbrek fonksiyon testlerinde bozulma sıklıkla gözlenir. Bizim olgumuzda da yapılan koroner anjiografi sonrası, sağ ayak başparmağında gangren, böbrek fonksiyonlarında bozulma, hipertansiyonda kötüleşme gelişmişti. Yapılan Doppler USG'de tromboemboli saptanmayan hastada KES olasılığı düşünüldü. Böbrek biyopsisi ile de tanısı doğrulanan hastaya steroid ve iloprost tedavisi uygulandı. Her iki alt ekstremite distalindeki lezyonlarında progresyon gözlenmeyen hastanın akut böbrek yetmezliği tablosu, başlangıçta hemodiyaliz ihtiyacı olmasına rağmen tedavi sonrası giderek düzeldi. Anahtar Kelimeler: Koroner anjiografi, kolesterol embolisi, damar içi girişimCholesterol embolism is a syndrome that is increasing in prevalence with intravascular diagnostic interventions, and which may be an etiologic factor in more than 3% of end-stage renal diseases. It is detected more frequently in diabetic, hypertensive male patients who smoke. Therapeutic approaches include the use of thrombolytic agents and heparin. The fundamental pathogenesis is the inflammatory and obliterative process of cholesterol crystals which separate from their site and join the distal arterial flow after intravascular interventions. In the clinic, symptoms such as accelerating hypertension, purpura and ecchymosis, abdominal pain, loss of weight, and failure in renal-function tests are frequently observed, as the kidneys, skin, gastrointestinal system and extremities are the most affected organs. Our patient developed gangrene in the right toe, failure in renal-function tests, and acceleration in hypertension after a cardiac angiogram. When a thromboembolism was not detected by venous doppler ultrasonography, the patient was diagnosed with a cholesterol embolism. Steroid therapy was initiated when the patient's diagnosis was confirmed by renal biopsy. The acute renal failure improved after therapy, and those manifestations on the distal lower limb did not progress.

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“…Th e third point concerns the possibility of attaining at least a temporary therapeutic response with an intensive treatment combining intravenous and oral corticosteroids and prostaglandin analogues in patients not on chronic renal replacement therapy, although with nonunivocal results [18][19][20][21][22][23][24] . Th is combined, relatively aggressive approach was eff ective in decreasing pain and allowing a healing tendency of the lesions in all the treated cases ( table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Cholesterol Crystal Embolism Syndrome in Dialysis Patients: An Emerging Clinical Diagnosis?

Piccoli

Fenoglio²,

Colla³

et al. 2006

Blood Purif

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Background: Cholesterol crystal embolism syndrome (CCE) is an increasing end-stage renal disease cause. Few cases have been described on dialysis, despite the high prevalence of the predisposing factors. Methods: The diagnostic criteria of the present study were: skin lesions, myalgia, fatigue, fever and acute inflammatory serologic signs, in the presence of severe vasculopathy. The precipitating factors were: anticoagulation, endovascular intervention and ulcerated atherosclerotic plaque. Results: Between October 2003 and September 2005, CCE was diagnosed in 6 dialysis patients (of 200–210 on chronic treatment): 5 males, 1 female, median age 59.5 years (47–70) and end-stage renal disease follow-up 11.5 years (3–25). All had severe vasculopathy, 5 cardiopathy, and 4 were failed graft recipients. The treatment included: peritoneal dialysis, daily dialysis, ‘conventional’ hemodialysis (2 cases) and hemodiafiltration. The diagnosis was based on the clinical-laboratory picture in 1 patient. In the 5 others clues were present (dicumarol therapy, angioplasty, femoral artery thrombosis, CCE predialysis and ulcerated aortic plaque). The therapeutic approach consisted of corticosteroids (5 cases), statins (4 cases) and prostaglandin analogues (4 cases). Conclusion: The differential diagnosis of CCE should also be considered in dialysis patients (necrotic lesions, limb pain and vasculitis-like signs).

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The Evaluation of Corticosteroid Therapy in Conjunction with Plasma Exchange in the Treatment of Renal Cholesterol Embolic Disease

Cited by 32 publications

References 18 publications

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

Cholesterol Crystal Embolism Following Coronary Angiography: A Case Report

Cholesterol Crystal Embolism Syndrome in Dialysis Patients: An Emerging Clinical Diagnosis?

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