| Atherosclerotic embolic nephropathy is a consequence of the embolisation of cholesterol crystals from the glomerular arteries. The atherosclerotic embolism of the kidneys forms part of the clinical spectrum of a more extensive symptomology, in which cholesterol crystal embolisms are produced in capillaries of different organs of the body.
The most well known predisposing factor is secondary to the handling of the aorta by interventions or catheterisation; it can also be produced after administration of anticoagulants or fibrinolytics and can even occur spontaneously. The incidence of this clinical picture is poorly known, but is probably around 2%. The clinical manifestations are livedo reticularis (or marble skin), abdominal pain, diarrhoea, GI haemorrhage, pancreatitis, ischaemic gall bladder, retinal microembolism (plates of Hollenhorst, see section "Images in series" in imagenmed http://www.imagenmed.com/especiales/ie6/ret03.html ) and acute or subacute renal failure.
The treatment is the same as that of renal failure. We present the case of a male with renal failure, livedo reticularis and retinal embolism after the implantation of a carotid stent.
Image 1: microembolisms of cholesterol crystals (arrows) in muscular capillaries
Image 2: digital embolisms, seen as sub-ungual flame haemorrhages
Image 3: livedo reticularis in the sole
Authors:
Francisco Pérez Gimenez and Rafael Ángel Fernández de la Puebla
Servicio de Medicina Interna
Hospital Reina Sofía
Córdoba España
Translation: Kelly
Watt
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