Atheroembolic renal disease
DefinitionAtheroembolic renal disease (AERD) occurs when small particles made of hardened cholesterol and fat spread to the small blood vessels of the kidneys.
Alternative NamesRenal disease - atheroembolic; Cholesterol embolization syndrome; Atheroemboli - renal; Atherosclerotic disease - renal
Causes, incidence, and risk factorsAERD is linked to atherosclerosis. Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form a hard substance called plaque.In AERD, cholesterol crystals break off from the plaque lining the arteries. These crystals move into the bloodstream. Once in circulation, the crystals get stuck in tiny blood vessels called arterioles. There, they reduce blood flow to tissues and cause swelling (inflammation) and tissue damage that can harm the kidneys or other parts of the bodyThe kidneys are involved about half of the time. Other body parts that may be involved include the skin, eyes, muscles and bones, brain and nerves, and organs in the abdomen. Acute kidney failure is possible if the blockages of the kidney blood vessels are severe.Atherosclerosis of the aorta is the most common cause of AERD. The cholesterol crystals may also break off during aortic angiography, cardiac catheterization or surgery of the aorta or other major arteries.In some cases, AERD may occur without a known cause.The risk factors for AERD are the same as risk factors for atherosclerosis, including age, male gender, cigarette smoking, high blood pressure, and diabetes.
SymptomsAERD may not cause any symptoms. If there are symptoms, they may begin suddenly, or slowly get worse over weeks or even months. Symptoms may include:BlindnessBlood in the urine (rare)Fever, muscle aches, headaches, and weight lossFlank (sides of the body) painFoot pain, sores on the feet, or blue toesHigh blood pressure that is hard to controlPain in the abdomen, nausea, or vomitingKidney failure may result in:Decrease in sensation (feeling)Decreased or no urine outputDrowsiness, confusion, lethargyDry itchy skinLoss of appetiteNausea or vomitingSkin color changesSwelling of the legsWeight loss
Signs and testsThe doctor will perform a physical exam. Swelling can start in the legs, but may affect the whole body. An eye exam may show particles in the small arteries of the retina.The doctor will listen to your lungs, heart, and large blood vessels with a stethoscope. Abnormal sounds may be heard. For example, a loud whooshing sound called a bruit may be heard over the aorta or renal artery.Blood pressure may be high. There may be many ulcers on the skin of the lower feet.Tests that may be done include:Abdominal CT scanAbdominal MRIAbdominal x-rayComplete blood countComprehensive metabolic panel (includes the kidney function tests BUN and creatinine)Kidney biopsyKidney or abdominal ultrasoundRenal arteriographySerum complementSerum lipidsUrinalysis
TreatmentThere is no treatment for atheroembolic kidney disease that works well. Treatment is focused on managing the complications of organ damage.Medicines may be used to treat high blood pressure and lower lipid and cholesterol levels.Your doctor may tell you to reduce fats and cholesterol in your diet.You may need other treatments for kidney failure or complications. If you have kidney failure, you may need to limit protein, salt, and fluids, or make other dietary changes.See:Chronic renal failureEnd-stage kidney diseaseYour doctor may also recommend other lifestyle changes, such as increased exercise or weight loss. Stopping smoking is very important.
Expectations (prognosis)The outcome varies but is generally poor. The disorder slowly gets worse over time. Lifestyle changes may help slow progression of the disease.
ComplicationsAcute renal failureBlood clots to other location of the body -- brain, intestine, legsChronic renal failureHigh blood pressure
Calling your health care providerCall your doctor if you have:A decrease in urine output or no urine productionBlood in the urineSevere abdominal pain or leg painToes that turn purple and occur with foot painUnexplained ulcers on your legs or feet
PreventionYou can change the factors that increase your risk of getting this disease:Lose weight if you are obese.Decrease or stop smoking.Follow your doctor's recommendations to control diabetes or high blood pressure.Reduce fats, especially saturated fats, in your diet to help to reduce blood lipid levels.
ReferencesDuBose TD Jr, Santos RM. Vascular disorders of the kidney. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 126.Kanso AA, Hassan NMA, Badr KF. Microvascular and macrovascular diseases of the kidney. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007:chap 32.