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Santamarina MG, Necochea Raffo JA, Lavagnino Contreras G, Recasens Thomas J, Volpacchio M. Predominantly multiple focal non-cystic renal lesions: an imaging approach. Abdom Radiol (NY) 2024:10.1007/s00261-024-04440-3. [PMID: 38913137 DOI: 10.1007/s00261-024-04440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024]
Abstract
Multiple non-cystic renal lesions are occasionally discovered during imaging for various reasons and poses a diagnostic challenge to the practicing radiologist. These lesions may appear as a primary or dominant imaging finding or may be an additional abnormality in the setting of multiorgan involvement. Awareness of the imaging appearance of the various entities presenting as renal lesions integrated with associated extrarenal imaging findings along with clinical information is crucial for a proper diagnostic approach and patient work-up. This review summarizes the most relevant causes of infectious, inflammatory, vascular, and neoplastic disorders presenting as predominantly multiple focal non-cystic lesions.
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Affiliation(s)
- Mario G Santamarina
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile.
- Radiology Department, Hospital Dr. Eduardo Pereira, Valparaiso, Chile.
| | - Javier A Necochea Raffo
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile
| | | | - Jaime Recasens Thomas
- Departamento de Radiología, Escuela de Medicina, Universidad de Valparaíso, Valparaiso, Chile
| | - Mariano Volpacchio
- Radiology Department, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
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2
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Rigattieri S, Cristiano E, Tempestini F, Pittorino L, Cesario V, Casenghi M, Giovannelli F, Tommasino A, Barbato E, Berni A. Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The Role of Vascular Access Site. J Clin Med 2024; 13:2367. [PMID: 38673640 PMCID: PMC11051292 DOI: 10.3390/jcm13082367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated by the reduction of bleeding and cholesterol crystal embolization into renal circulation, has been investigated in several studies, yielding conflicting results. Methods: we designed a retrospective study to appraise the effect of the use of a vascular access site on the occurrence of AKI in a cohort of 633 patients with acute myocardial infarction treated by PCI at our centre from 2018 to 2020. Results: after propensity score adjustment, radial access was associated with a reduced, albeit statistically not significant, incidence of AKI (14.7% vs. 21.0%; p = 0.06) and major bleeding (12.5% vs. 18.7%; p = 0.04) as compared to femoral access. At multivariate analysis, femoral access was an independent predictor of AKI, together with in-hospital occurrence of BARC 3-5 bleeding, Killip class >1 at presentation, female gender, baseline eGFR <60 mL/min, and baseline haemoglobin <12 g/dL. Conclusions: although limited by the observational design, our study supports the hypothesis that radial access may exert a protective role on the occurrence of AKI in patients with acute myocardial infarction undergoing PCI.
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Affiliation(s)
- Stefano Rigattieri
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Ernesto Cristiano
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
- Department of Electrophysiology, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Federica Tempestini
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Luca Pittorino
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Vincenzo Cesario
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Matteo Casenghi
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Francesca Giovannelli
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Antonella Tommasino
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Emanuele Barbato
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Berni
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
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3
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Suzuki M, Watari T. Blue toe syndrome caused by spontaneous cholesterol embolization syndrome. QJM 2023; 116:936-937. [PMID: 37471693 DOI: 10.1093/qjmed/hcad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- M Suzuki
- Department of General Internal Medicine, National Hospital Organization Sendai Medical Center, Miyagi, Japan
| | - T Watari
- Department of Internal Medicine, University of Michigan Medical School, MI, USA
- General Medicine Centre, Shimane University Hospital, Shimane, Japan
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4
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Kano Y, Shigehara Y. Blue toe syndrome caused by cholesterol crystal embolisation in a patient with warfarin use. BMJ Case Rep 2023; 16:e257927. [PMID: 37798039 PMCID: PMC10565294 DOI: 10.1136/bcr-2023-257927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yohya Shigehara
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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5
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Chaudhary S, Kashani KB. Acute Kidney Injury Management Strategies Peri-Cardiovascular Interventions. Interv Cardiol Clin 2023; 12:555-572. [PMID: 37673499 DOI: 10.1016/j.iccl.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
In many countries, the aging population and the higher incidence of comorbid conditions have resulted in an ever-growing need for cardiac interventions. Acute kidney injury (AKI) is a common complication of these interventions, associated with higher mortalities, chronic or end-stage kidney disease, readmission rates, and hospital and post-discharge costs. The AKI pathophysiology includes contrast-associated AKI, hemodynamic changes, cardiorenal syndrome, and atheroembolism. Preventive measures include limiting contrast media dose, optimizing hemodynamic conditions, and limiting exposure to other nephrotoxins. This review article outlines the current state-of-art knowledge regarding AKI pathophysiology, risk factors, preventive measures, and management strategies in the peri-interventional period.
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Affiliation(s)
- Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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6
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Shi C, Mammadova-Bach E, Li C, Liu D, Anders HJ. Pathophysiology and targeted treatment of cholesterol crystal embolism and the related thrombotic angiopathy. FASEB J 2023; 37:e23179. [PMID: 37676696 DOI: 10.1096/fj.202301316r] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
Cholesterol crystal (CC) embolism is a complication of advanced atherosclerotic plaques located in the major arteries. This pathological condition is primarily induced by interventional and surgical procedures or occurs spontaneously. CC can induce a wide range of tissue injuries including CC embolism syndrome, a spontaneous or intervention-induced complication of advanced atherosclerosis, while treatment of CC embolism has remained empiric. Vascular occlusions caused by CC embolism may exceed the ischemia tolerance of many tissues, particularly when small arteries are affected. The main approach to CC embolism is primary prophylaxis in patients at risk by stabilizing atherosclerotic plaques and avoiding unnecessary catheter interventions. During CC embolism, the use of platelet inhibitors to avoid abnormal activation and aggregation and anticoagulants may reduce the risk of vascular occlusions and tissue ischemia. This probably explains the relatively low prevalence of clinical manifestations of CC embolism, which are frequently found in autopsy studies. In this review, we summarized the current knowledge on the pathophysiology of CC embolism syndrome deriving from clinical observations and experimental mouse models. Furthermore, we described the risk factors of CC embolism in humans as well as the experimental studies based on empiric treatments. We also discuss potential therapeutic interventions based on recent experimental data and emerging drug options evolving from other research domains. Given the substantial unmet medical need to improve the outcomes of CC embolism, the identification of effective treatment strategies is urgently needed.
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Affiliation(s)
- Chongxu Shi
- Nantong Laboratory of Development and Diseases, School of Life Sciences, Medical College, Nantong University, Nantong, China
| | - Elmina Mammadova-Bach
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Cong Li
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Dong Liu
- Nantong Laboratory of Development and Diseases, School of Life Sciences, Medical College, Nantong University, Nantong, China
| | - Hans-Joachim Anders
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
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7
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Karaaslan H, Uyar N, Göçer EG, Cindoğlu Ç, Eren MA, Sabuncu T. An Analysis of the Prevalence and Risk Factors of Contrast-Associated Acute Kidney Injury in Patients With Diabetic Foot Ulcer. Angiology 2023; 74:624-630. [PMID: 36744995 DOI: 10.1177/00033197231155581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The occurrence of contrast-associated acute kidney injury (CA-AKI) is influenced by both patient-related and contrast-related factors. More specifically, CA-AKI has been linked to renal dysfunction, diabetes mellitus (DM), and atherosclerotic cardiovascular diseases (ASCVD). We hypothesized that the prevalence of CA-AKI was high in patients with diabetic foot ulcers (DFU) because they frequently have several ASCVD risk factors and additional comorbid conditions (including ASCVD). We retrospectively examined the medical records of 208 type 2 diabetic patients who were hospitalized for DFU. These patients were divided into two groups: group 1 included 107 patients who underwent contrast-enhanced computed tomographic angiography (CTA); group 2 (control group) included 101 patients who did not receive contrast media. Following CTA, 13 (12.1%) patients developed CA-AKI in group 1, while 3 (3.0%) patients in group 2 had serum creatinine elevations consistent with AKI (P = 0.013). The following risk factors for CA-AKI were identified: longer history of DM, higher baseline serum creatinine, congestive heart failure, Wagner stage 4 and 5 DFUs, peripheral artery disease, older age, and lower hemoglobin values. CA-AKI is a common complication after CTA in patients with DFU. To reduce the risk of CA-AKI in these patients, associated risk factors and preventive measures should be considered.
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Affiliation(s)
- Hüseyin Karaaslan
- Department of Endocrinology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Nida Uyar
- Department of Endocrinology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Ensar Gazi Göçer
- Department of Internal Medicine, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Çiğdem Cindoğlu
- Department of Internal Medicine, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Mehmet Ali Eren
- Department of Endocrinology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Tevfik Sabuncu
- Department of Endocrinology, School of Medicine, Harran University, Sanliurfa, Turkey
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8
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Yang L, Steiger S, Shi C, Gudermann T, Mammadova-Bach E, Braun A, Anders HJ. Both hyperglycemia and hyperuricemia aggravate acute kidney injury during cholesterol embolism syndrome despite opposite effects on kidney infarct size. Kidney Int 2023; 104:139-150. [PMID: 37001603 DOI: 10.1016/j.kint.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/08/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
Kidney cholesterol crystal embolism (CCE) occurs in advanced atherosclerosis and induces a thrombotic (micro)angiopathy, a drop in the glomerular filtration rate (GFR), and an ischemic kidney infarction with necroinflammation. We speculated that common metabolic comorbidities such as diabetes or hyperuricemia would independently modulate each of these distinct pathophysiological processes. To test this, experimental CCE was induced by injecting cholesterol crystals into the left kidney artery of mice and thrombotic angiopathy, GFR drop, and infarct size were analyzed after 24 hours in the presence of hyperglycemia (about 500 mg/dL) or hyperuricemia (about 8 mg/dL) or their absence. In healthy mice, unilateral CCE caused diffuse thrombotic angiopathy in interlobar, arcuate and interlobular arteries, followed by a 50% or less drop in GFR compared to baseline and a variable degree of ischemic kidney necrosis. Hyperglycemia but not hyperuricemia aggravated thrombotic angiopathy although both caused a GFR decline, albeit via different mechanisms. Hyperglycemia aggravated GFR loss by increasing necroinflammation and infarct size, while the antioxidative effects of hyperuricemia reasonably attenuated necroinflammation and infarct size but induced a diffuse vasoconstriction in affected and unaffected kidney tissue. Thus, both hyperglycemia or hyperuricemia aggravate CCE-induced acute kidney failure despite having opposite effects on ischemic necroinflammation and infarction.
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Affiliation(s)
- Luying Yang
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Stefanie Steiger
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Chongxu Shi
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany; School of Life Sciences, Nantong Laboratory of Development and Diseases, Medical College, Nantong University, Nantong, China
| | - Thomas Gudermann
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig Maximilian University, Munich, Germany
| | - Elmina Mammadova-Bach
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany; Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig Maximilian University, Munich, Germany
| | - Attila Braun
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig Maximilian University, Munich, Germany
| | - Hans-Joachim Anders
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany.
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9
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Gaspert A, Büttner-Herold M, Amann K. [Basic nephropathology for pathologists-part 2 : Non-inflammatory lesions]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00292-023-01204-6. [PMID: 37368052 DOI: 10.1007/s00292-023-01204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 06/28/2023]
Abstract
The evaluation of kidney biopsies for specific renal diseases or kidney transplant biopsies is mainly restricted to specialized centers. Lesions in nonneoplastic renal tissue in partial nephrectomies or nephrectomies due to renal tumors, especially noninflammatory, ischemic, vascular changes or diabetic nephropathy can be of greater prognostic significance than the tumor itself in patients with a localized tumor and good tumor-associated survival. In this part of basic nephropathology for pathologists, the most common noninflammatory lesions of the vascular, glomerular and tubulo-interstitial compartment are discussed.
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Affiliation(s)
- Ariana Gaspert
- Abteilung für Nephropathologie, Institut für Pathologie und Molekularpathologie, Universitätsspital Zürich, Schmelzbergstr. 12, 8091, Zürich, Schweiz.
| | - Maike Büttner-Herold
- Abteilung für Nephropathologie, Institut für Pathologie, Friedrich-Alexander Universität Erlangen-Nürnberg und Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Kerstin Amann
- Abteilung für Nephropathologie, Institut für Pathologie, Friedrich-Alexander Universität Erlangen-Nürnberg und Universitätsklinikum Erlangen, Erlangen, Deutschland
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10
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Mahtani AU, Tahir MK, Padda I, Haider M, Ebrahimi F, Otterbeck P, Nfonoyim J. Spontaneous Cholesterol Embolism Leading to Small Bowel Obstruction and Perforation. JACC Case Rep 2023; 13:101780. [PMID: 37153475 PMCID: PMC10157106 DOI: 10.1016/j.jaccas.2023.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 05/09/2023]
Abstract
A spontaneous occurrence of cholesterol embolization syndrome causing small bowel obstruction and perforation is a highly scarce event. In this article, we report a case of spontaneous cholesterol embolism resulting in small bowel obstruction and perforation in a 52-year-old male with multiple cardiovascular and medical comorbidities. In our patient, the source was an eccentric left lateral atherosclerotic plaque from the abdominal aorta that was identified using computed tomography. A distal occlusion in numerous small intestinal arteries due to cholesterol embolism was confirmed on biopsy after surgical resection. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Arun Umesh Mahtani
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
- Address for correspondence: Dr Arun Umesh Mahtani, 1059, 7 Navy Pier Court, Staten Island, New York 10304, USA.
| | - Muhammad Khalid Tahir
- Department of Nephrology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Inderbir Padda
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Muhammad Haider
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Farhang Ebrahimi
- Department of Nephrology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Philip Otterbeck
- Department of Endocrinology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Jay Nfonoyim
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
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11
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Bahloul M, Makni A, Kharrat S, Alila I, Suissi B, Bouaziz M. A possible cause of cholesterol crystal embolism in a polytrauma patient? JOURNAL DE MEDECINE VASCULAIRE 2023; 48:88-90. [PMID: 37422333 DOI: 10.1016/j.jdmv.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/09/2023] [Indexed: 07/10/2023]
Affiliation(s)
- M Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia.
| | - A Makni
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia
| | - S Kharrat
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia
| | - I Alila
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia
| | - B Suissi
- Department of Radiology, Habib Bourguiba Hospital, Sfax University, Sfax, Tunisia
| | - M Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia
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12
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A comparison of thoracoabdominal aortic aneurysms open repair in patients with or without "shaggy aorta". J Vasc Surg 2023; 77:347-356.e2. [PMID: 36243266 DOI: 10.1016/j.jvs.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the field of thoracoabdominal aortic aneurysm (TAAA) open surgical repair (OSR), some preoperative characteristics are established risk factors for adverse outcomes, whereas others are supposed to be relevant, but their role still need to be defined; among them, the presence of "shaggy aorta" (SA), an extensive and irregular atheroma within the aorta. The aim of this study is to report the results of a single-center large cohort of patients treated with OSR for TAAA with SA, comparing the outcomes with patients affected by TAAA without SA, and analyzing the impact of the scores for SA on the outcomes. METHODS All consecutive patients receiving OSR for TAAA between 2012 and 2021 were retrospectively analyzed. Clinical data from patients with degenerative TAAA were included and analyzed for preoperative characteristics and postoperative outcomes; patients with ruptured TAAA, and patients with aortic dissection were excluded from the analysis. Patients with degenerative aortic aneurysm, thrombus measurement in non-aneurysmal aortic segments (≤40 mm), atheroma thickness ≥5 mm, and finger-like thrombus projection were included in the SA group, whereas the others were included in the non-shaggy aorta group (NSA group). The SA group and NSA group were compared using a propensity-matched comparison. Preoperative computed tomography scans of patients in the SA group were also stratified according to SA grading scores. RESULTS A total of 58 patients with SA were identified (male, n = 43 [74.1%], mean age 70.1 ± 7.8 years) among 497 patients with TAAA treated with open surgical repair. After propensity matching, there were 57 patients in the SA group and 57 in the NSA group with correction of all differences in baseline characteristics. Patients in the SA group presented significantly higher in-hospital mortality (SA group, 14.0% vs NSA group, 3.5%; P = .047), postoperative acute renal failure (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease [RIFLE], 3-5) (SA group, 21.1% vs NSA group, 5.3%; P = .013), and postoperative embolization (SA group, 28.1% vs NSA group, 8.8%; P = .008). Spinal cord ischemia and stroke rate were not significantly influenced by the presence of SA. In the SA group, 16 patients (27.6%) with end-organ embolization were compared with 42 patients (72.4%) without a documented embolization considering the grade of aortic "shagginess" and no significant difference was identified (P = .546). CONCLUSIONS Despite a better knowledge of the SA disease, new classifications, and intraoperative adjuncts, TAAA patients with SA treated with OSR have worse postoperative outcomes if compared with patients without SA. The presence of SA is a risk factor itself, whereas the grade of "shagginess" seems not to impact on postoperative outcomes.
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13
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Lyubenov L, Shi C, Zhao D, Yang L, Lei Y, Mammadova-Bach E, de Chiara L, Semeraro R, Landini S, Romagnani P, Vörg E, Devarapu SK, Welz R, Kiessig ST, Anders HJ. Intravenous Glu-plasminogen attenuates cholesterol crystal embolism-induced thrombotic angiopathy, acute kidney injury and kidney infarction. Nephrol Dial Transplant 2023; 38:93-105. [PMID: 36102665 DOI: 10.1093/ndt/gfac273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cholesterol crystal (CC) embolism causes acute kidney injury (AKI) and ischaemic cortical necrosis associated with high mortality. We speculated that sustaining the fibrinolytic system with Glu-plasminogen (Glu-Plg) could be a safe way to attenuate AKI and prevent ischaemic infarction upon CC embolism. METHODS We induced CC embolism by injecting CC into the left kidney artery of C57BL/6J mice. The primary endpoint was glomerular filtration rate (GFR). RESULTS Starting as early as 2 h after CC embolism, thrombotic angiopathy progressed gradually in the interlobular, arcuate and interlobar arteries. This was associated with a decrease of GFR reaching a peak at 18 h, i.e. AKI, and progressive ischaemic kidney necrosis developing between 12-48 h after CC injection. Human plasma Glu-Plg extracts injected intravenously 4 h after CC embolism attenuated thrombotic angiopathy, GFR loss as well as ischaemic necrosis in a dose-dependent manner. No bleeding complications occurred after Glu-Plg injection. Injection of an intermediate dose (0.6 mg/kg) had only a transient protective effect on microvascular occlusions lasting for a few hours without a sustained protective effect on AKI at 18-48 h or cortical necrosis, while 1.5 mg/kg were fully protective. Importantly, no bleeding complications occurred. CONCLUSIONS These results provide the first experimental evidence that Glu-Plg could be an innovative therapeutic strategy to attenuate thrombotic angiopathy, AKI, kidney necrosis and potentially other clinical manifestations of CC embolism syndrome.
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Affiliation(s)
- Lyuben Lyubenov
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Chongxu Shi
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Danyang Zhao
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Luying Yang
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Yutian Lei
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
| | - Elmina Mammadova-Bach
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany.,Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian-University, Munich, Germany
| | - Letizia de Chiara
- Department of Experimental and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Roberto Semeraro
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Samuela Landini
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Paola Romagnani
- Department of Experimental and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Vörg
- PreviPharma Consulting GmbH, Mannheim, Germany
| | | | | | | | - Hans-Joachim Anders
- Department of Medicine IV, Hospital of Ludwig-Maximilian-University, Munich, Germany
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14
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Riese N, Smart Y, Bailey M. Asymptomatic retinal emboli and current practice guidelines: a review. Clin Exp Optom 2023; 106:4-9. [PMID: 35109784 DOI: 10.1080/08164622.2022.2033600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Asymptomatic retinal emboli are found in 1-3% of patients on routine fundus examination. As the use of teleretinal imaging for diabetic patients and ocular photography continues to increase, the number of asymptomatic retinal emboli found will also increase. This article will discuss the different aetiologies of retinal emboli and will present an overview of the recommended referrals for further systemic testing and treatment. It is important to communicate well with the primary care physician when asymptomatic retinal emboli are detected to ensure the appropriate investigations are undertaken.
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Affiliation(s)
- Nicole Riese
- Department of Optometry, VA New Jersey Healthcare System, Brick, NJ, USA
| | - Yelena Smart
- Department of Optometry, VA New Jersey Healthcare System, Brick, NJ, USA
| | - Melissa Bailey
- Department of Neurology, University of Miami, Miami, FL, USA
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15
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Yamashita J, Nosaka T, Takahashi K, Naito T, Ofuji K, Matsuda H, Ohtani M, Hiramatsu K, Kobayashi M, Nakamoto Y. Cholesterol crystal embolism in multiple organs after transarterial chemoembolization for hepatocellular carcinoma: An autopsy case report. Medicine (Baltimore) 2022; 101:e30769. [PMID: 36181036 PMCID: PMC9524960 DOI: 10.1097/md.0000000000030769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) rarely causes cholesterol crystal embolism (CCE). In our case, the histological findings suggested that the onset of CCE occurred at different time points in different organs. PATIENT CONCERNS A 72-year-old Japanese woman with HCC underwent TACE. After TACE, serum creatinine level and eosinophil count gradually increased. Three months later, she was admitted to our department with a fever and back pain. DIAGNOSIS Laboratory examinations showed sepsis with disseminated intravascular coagulation. She was treated with antimicrobial agents and anticoagulants, but died of multiple organ failure. INTERVENTIONS An autopsy was performed to examine the cause of multiple organ failure after 3 months of TACE. OUTCOMES A mixture of both chronic phase emboli with intimal thickening and fibrosis and acute phase emboli with inflammatory cell infiltration were observed in the small intestine. Moreover, multiple intravascular cholesterol fissures were observed in the kidney, stomach, duodenum, colon, pancreas, and spleen, which were the vascular dominant organs of the celiac artery and superior mesenteric artery. These histological findings suggested that cholesterol crystals were continuously disseminated after TACE. LESSONS TACE for HCC may cause progressive CCE and damage in multiple organs. When progressive renal dysfunction, eosinophilia, or multiple organ dysfunction is observed after TACE, the CCE should be suspected.
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Affiliation(s)
- Junki Yamashita
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takuto Nosaka
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuto Takahashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tatsushi Naito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuya Ofuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hidetaka Matsuda
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masahiro Ohtani
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Katsushi Hiramatsu
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Motohiro Kobayashi
- Department of Tumor Pathology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- *Correspondence: Yasunari Nakamoto, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan (e-mail: )
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16
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Shi C, Zhao D, Lyubenov L, Motrapu M, Li N, Steiger S, Mammadova-Bach E, Yang L, Liu D, Anders HJ. Neutrophil circadian rhythm is associated with different outcomes of acute kidney injury due to cholesterol crystal embolism. Front Cardiovasc Med 2022; 9:974759. [PMID: 35966530 PMCID: PMC9366331 DOI: 10.3389/fcvm.2022.974759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Cholesterol crystal (CC) embolism can cause acute tissue infarction and ischemic necrosis via triggering diffuse thrombotic angiopathy occluding arterioles and arteries. Neutrophils contribute to crystal-induced immunothrombosis as well as to ischemic necrosis-related necroinflammation. We speculated that CC embolism-induced acute kidney injury (AKI) would be circadian rhythm-dependent and associated with cyclic differences in neutrophil function. Injection of CC into the left kidney induced thrombotic angiopathy progressing starting as early as 3 h after CC injection followed by a progressive ischemic cortical necrosis and AKI at 24 h. In C57BL/6J mice, circulating CD11b+Ly6G+ neutrophils were higher during the day phase [Zeitgeber time (ZT) 0–12] compared to the dark phase (ZT12-24). In the time frame of thrombus formation at ZT13, more neutrophils were recruited into the injured kidney 24 h later compared to CC embolism at ZT5. This effect was associated with an increased circulating number of CXCR2+ neutrophils as well as an upregulated kidney adhesion molecule and chemokine expression. These findings were associated with a significant increase in kidney necrosis, and endothelial injury at ZT13. Thus, the time of day has an effect also on CC embolism-related AKI in association with the circadian rhythm of neutrophil recruitment.
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Affiliation(s)
- Chongxu Shi
- Nantong Laboratory of Development and Diseases, School of Life Sciences, Medical College, Nantong University, Nantong, China
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Danyang Zhao
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Lyuben Lyubenov
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Manga Motrapu
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Na Li
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
- Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Stefanie Steiger
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Elmina Mammadova-Bach
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Luying Yang
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
| | - Dong Liu
- Nantong Laboratory of Development and Diseases, School of Life Sciences, Medical College, Nantong University, Nantong, China
- Co-Innovation Center of Neuroregeneration, Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, Nantong, China
| | - Hans-Joachim Anders
- Renal Division, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany
- *Correspondence: Hans-Joachim Anders
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17
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Büttner-Herold M, Gaspert A, Amann K. [Basic nephropathology for pathologists-part 1 : Kidney biopsy-inflammation and immune complexes]. DER PATHOLOGE 2022; 43:231-246. [PMID: 35344060 DOI: 10.1007/s00292-022-01061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
The assessment of kidney biopsies is mainly confined to specialized centres. However, sometimes a kidney biopsy is submitted to a general pathologist, and in addition peritumorous renal parenchyma in tumour nephrectomies can have concomitant non-neoplastic renal disease. Here we present a survey of inflammatory and immunologic changes in all renal compartments, which may in part indicate the need of prompt therapeutic intervention such as in vasculitis, glomerulonephritis and interstitial nephritis. It is important to take into account that renal involvement of vasculitis is mainly centred in glomeruli and only to a much lesser extent in arteries, and that the frequently observed interstitial inflammation very often is an epiphenomenon of another primary kidney disease and not an independent disease process. Typical renal patterns of injury are emphasised.
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Affiliation(s)
- Maike Büttner-Herold
- Abteilung Nephropathologie, Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland.
| | - Ariana Gaspert
- Abt. Nephropathologie, Institut für Pathologie und Molekularpathologie, Universitätsspital Zürich, Schmelzbergstr. 12, 8091, Zürich, Schweiz
| | - Kerstin Amann
- Abteilung Nephropathologie, Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland
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18
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Testa A, Chamorey E, Lavainne F, Verger C. Outcomes of patients with Cholesterol crystal embolism treated by peritoneal dialysis: retrospective study from the RDPLF registry. BULLETIN DE LA DIALYSE À DOMICILE 2022. [DOI: 10.25796/bdd.v5i1.65303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cholesterol crystal embolisms disease (CED) is a systemic disease characterized by tissue ischemia and microinflammation related to occlusion of arterioles by microemboli from ulcerated atheromatous plaques. The kidney is one of the most affected organs, often requiring dialysis. Our study examines the outcomes of a cohort of patients with CED treated with peritoneal dialysis (PD). As anticoagulants can favor emboli, peritoneal dialysis may theoretically have an advantage.
From the database of the French Language Peritoneal Dialysis Registry (RDPLF), between January 1, 1995, and December 31, 2021, we selected patients treated with PD for >90 days and with an age >18 years. On the basis of the variables of patient autonomy, diabetes, BMI, modified Charlson index, age, sex, pre-PD treatment, causes of death, causes of transfer to hemodialysis, and peritonitis, three types of survival were estimated (patient, technical, and composite). After adjustment by propensity scores and taking into account competitive risks, 2 groups of patients were constituted on the basis of baseline nephropathy: emboli group vs. control group.
Patient survival and strict technical survival are not associated with the type of nephropathy (CED versus others). Composite technical survival (uncensored for deaths and transfers to hemodialysis) was only associated with cholesterol emboli nephropathy in the multivariate analysis adjusted for diabetes, autonomy, and age of the patient at the start of the dialysis treatment (p=0.011; 95% CI [0.736 [0.581-0.931]]).
Our study from the RDPLF database shows no difference in technical and patient survival in a cohort of patients with CED vs. a control group. It also confirms that PD may represent an adequate choice in this pathology.
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19
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Finke M, Kümpers P, Rovas A. [Epidemiology and Causes of Acute Renal Failure and Transition to Chronic Kidney Disease]. Dtsch Med Wochenschr 2022; 147:227-235. [PMID: 35226921 DOI: 10.1055/a-1531-9023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute kidney injury (AKI) refers to an acute functional deterioration of the kidneys, which leads to retention of urinary substances, dysregulation of the electrolyte and acid-base balance, and disturbance of fluids. Although didactically helpful, the oversimplified AKI classification of prerenal/renal/postrenal is currently considered obsolete. Indeed, the boundaries blur quite quickly, particularly between prerenal and renal causes. Based on the AKI pathophysiology, it can be etiologically divided into decreased renal perfusion, postrenal obstruction and kidney specific injury or unspecific injury. AKI is a common event in hospitalized patients and associates strongly with mortality and chronic kidney disease (CKD). Today it is accepted that AKI and CKD are rather an individually variable continuum, than 2 distinct entities. If AKI has not regressed after 7 days, it is referred to as acute kidney disease (AKD). Persisting AKD for > 90 days is classified as CKD. The transition from AKD to CKD is the result of an incomplete and maladaptive repair process. Although follow-up of post-AKI patients is essential, optimal concepts still need to be developed.
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20
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Ness B, Heady B. Acute Kidney Injury. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Kondo Y, Kanzaki M, Ishima D, Usui R, Kimura A, Usui K, Amoh Y, Takeuchi Y, Kumabe T, Ako J, Miyaji K, Nishiyama K, Akutsu T. Cholesterol crystal embolism-related cerebral infarction: Magnetic resonance imaging and clinical characteristics. eNeurologicalSci 2022; 25:100388. [PMID: 34977369 PMCID: PMC8683713 DOI: 10.1016/j.ensci.2021.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 12/01/2022] Open
Abstract
Background and aims Cholesterol crystal embolism-related cerebral infarction (CCE-CI) is frequently misdiagnosed due to the lack of specific symptoms. To aid in differential diagnosis, this study comprehensively characterized the magnetic resonance imaging (MRI) and clinical manifestations of CCE-CI and compared these features to those of atherothrombotic cerebral infarction (ACI). Methods This single-center, retrospective, observational study was conducted at Kitasato University Hospital, Kanagawa, Japan. We identified 37 clinically or histopathologically confirmed CCE-CI cases and 110 ACI cases treated from January 2006 to May 2020. Groups were compared for mean age, sex ratio, clinical presentations, imaging manifestations, precipitating factors, comorbid conditions, medications, and smoking history. Results Of 37 eligible patients with CCE-CI, 10 (27.0%) received brain MRI, of which 8 (21.6%) exhibited high-intensity signals indicative of brain lesions on diffusion-weighted imaging (DWI). However, two patients with DWI lesions exhibited no detectable neurological abnormalities. Patients with CCE-CI frequently demonstrated bilateral DWI lesions involving the bilateral anterior and posterior circulation, a pattern absent in ACI (50% vs. 0%, p < 0.001). Compared to patients with ACI, CCE-CI patients also demonstrated significantly lower estimated glomerular filtration rate (p < 0.001) as well as more frequent eosinophilia (p = 0.006), atherosclerotic plaques ≥4-mm thick in the ascending aorta or proximal arch (p = 0.001), and aortic aneurysm (p < 0.001). Conclusions Patients with CCE-CI develop multiple DWI lesions across several vascular territories, even in the absence of neurological symptoms. Comorbid aortic aneurysm may increase CCE-CI risk. These findings could help in the differential diagnosis of CCE-CI. Diagnosis of CCE-CI is challenging due to nonspecific neurological symptoms. Brain DWI revealed multiple small ischemic lesions among patients with CCE-CI. CCE-CI was associated with atherosclerotic plaques in the ascending aorta and arch. CCE-CI was also associated with lower eGFR and higher blood eosinophil count. CCE-CI is associated with aortic aneurysm morbidity.
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Key Words
- ACI, Atherothrombotic cerebral infarction
- Atheroembolism
- Atherothrombotic cerebral infarction
- CAS, Carotid artery stenting
- CCE, Cholesterol crystal embolism
- CI, Confidence intervals
- CRP, C-reactive protein
- CTA, Computed tomography angiography
- Cerebral infarction
- Cholesterol crystal embolism
- Cholesterol crystal embolism-related cerebral infarction
- DWI, Diffusion-weighted imaging
- Diffusion-weighted imaging
- IRB, Institutional review board
- LDL, Low-density lipoprotein
- MRA, Magnetic resonance angiography
- MRI, Magnetic resonance imaging
- OR, Odds ratios
- PCI, Percutaneous coronary intervention
- TIA, Transient ischemic attack
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Affiliation(s)
- Yuko Kondo
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mami Kanzaki
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
| | - Daisuke Ishima
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
| | - Ryo Usui
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
| | - Ayato Kimura
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
| | - Kotaro Usui
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
| | - Yasuyuki Amoh
- Department of Dermatology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasuo Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kazutoshi Nishiyama
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
| | - Tsugio Akutsu
- Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.,Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan
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22
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Aklilu AM. Eosinophilia and Skin Rash in a Patient with Uncontrolled Hypertension and AKI. KIDNEY360 2021; 2:2038-2039. [PMID: 35419544 PMCID: PMC8986042 DOI: 10.34067/kid.0004422021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
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23
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Scott T, Ethier I, Hawley C, Pascoe EM, Viecelli AK, Ng A, Cho Y, Johnson DW. Burden of kidney failure from atheroembolic disease and association with survival in people receiving dialysis in Australia and New Zealand: a multi-centre registry study. BMC Nephrol 2021; 22:401. [PMID: 34856938 PMCID: PMC8638445 DOI: 10.1186/s12882-021-02604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background Cardiovascular disease is a leading cause of mortality in kidney failure (KF). Patients with KF from atheroembolic disease are at higher risk of cardiovascular disease than other causes of KF. This study aimed to determine survival on dialysis for patients with KF from atheroembolic disease compared with other causes of KF. Methods All adults (≥ 18 years) with KF initiating dialysis as the first kidney replacement therapy between 1 January 1990 and 31 December 2017 according to the Australia and New Zealand Dialysis and Transplant registry were included. Patients were grouped into either: KF from atheroembolic disease and all other causes of KF. Survival outcomes were assessed by the Kaplan-Meier method and Cox regression analysis adjusted for patient-related characteristics. Results Among 65,266 people on dialysis during the study period, 334 (0.5%) patients had KF from atheroembolic disease. A decreasing annual incidence of KF from atheroembolic disease was observed from 2008 onwards. Individuals with KF from atheroembolic disease demonstrated worse survival on dialysis compared to those with other causes of KF (HR 1.80, 95% confidence interval [CI] 1.61–2.03). The respective one- and five-year survival rates were 77 and 23% for KF from atheroembolic disease and 88 and 47% for other causes of KF. After adjustment for patient characteristics, KF from atheroembolic disease was not associated with increased patient mortality (adjusted HR 0.93 95% CI 0.82–1.05). Conclusions Survival outcomes on dialysis are worse for individuals with KF from atheroembolic disease compared to those with other causes of KF, probably due to patient demographics and higher comorbidity.
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Affiliation(s)
- Tahira Scott
- Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia. .,School of Medicine, University of Queensland, Brisbane, Australia.
| | - Isabelle Ethier
- Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.,Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Carmel Hawley
- Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Arnold Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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24
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Iwa N, Yutani C, Komatsu S, Takahashi S, Takewa M, Ohara T, Kodama K. Novel Methods for Detecting Human Cholesterol Crystals from Sampled Blood. Lab Med 2021; 53:255-261. [PMID: 34755193 DOI: 10.1093/labmed/lmab078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Nonobstructive general angiography (NOGA) is a novel modality to detect and sample spontaneous ruptured aortic plaques (SRAPs). We aimed to establish novel methods to detect cholesterol crystals (CCs) in sampled SRAPs. METHODS Blood specimens containing SRAPs were obtained from patients using NOGA. Blood was instantly frozen on a glass slide and subsequently thawed for quantitative analysis and spread onto a filter paper that was rinsed using distilled water. Qualitative analysis was performed for the rinsed water using polarized light microscopy, and the filter paper was embedded in paraffin for histologic analysis. RESULTS The CCs were clearly observed after hemolysis using the instant freeze-thaw method. The filter paper rinse method indicated free CCs of varying shapes under polarized light microscopy without erythrocytes. On the filter paper, sampled SRAPs showed Lamé-like small particles. Histopathology revealed various atheromatous components. CONCLUSION A set of novel methods for detecting CCs from sampled blood was established.
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Affiliation(s)
- Nobuzo Iwa
- Division of Pathology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Chikao Yutani
- Division of Pathology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Sei Komatsu
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Satoru Takahashi
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Mitsuhiko Takewa
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Tomoki Ohara
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Kazuhisa Kodama
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
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25
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Baumer Y, McCurdy SG, Boisvert WA. Formation and Cellular Impact of Cholesterol Crystals in Health and Disease. Adv Biol (Weinh) 2021; 5:e2100638. [PMID: 34590446 PMCID: PMC11055929 DOI: 10.1002/adbi.202100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/20/2021] [Indexed: 11/10/2022]
Abstract
Cholesterol crystals (CCs) were first discovered in atherosclerotic plaque tissue in the early 1900 and have since been observed and implicated in many diseases and conditions, including myocardial infarction, abdominal aortic aneurism, kidney disease, ocular diseases, and even central nervous system anomalies. Despite the widespread involvement of CCs in many pathologies, the mechanisms involved in their formation and their role in various diseases are still not fully understood. Current knowledge concerning the formation of CCs, as well as the molecular pathways activated upon cellular exposure to CCs, will be explored in this review. As CC formation is tightly associated with lipid metabolism, the role of cellular lipid homeostasis in the formation of CCs is highlighted, including the role of lysosomes. In addition, cellular pathways and processes known to be affected by CCs are described. In particular, CC-induced activation of the inflammasome and production of reactive oxygen species, along with the role of CCs in complement-mediated inflammation is discussed. Moreover, the clinical manifestation of embolized CCs is described with a focus on renal and skin diseases associated with CC embolism. Lastly, potential therapeutic measures that target either the formation of CCs or their impact on different cell types and tissues are highlighted.
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Affiliation(s)
- Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, Building 10, 10 Center Drive, Bethesda, MD 20814, USA
| | - Sara G. McCurdy
- Dept. of Medicine, University of California San Diego, 9500 Gilman Street, La Jolla, CA 92093, USA
| | - William A. Boisvert
- Center for Cardiovascular Research, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA
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26
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Rachoin JS, Wolfe Y, Patel S, Cerceo E. Contrast associated nephropathy after intravenous administration: what is the magnitude of the problem? Ren Fail 2021; 43:1311-1321. [PMID: 34547972 PMCID: PMC8462873 DOI: 10.1080/0886022x.2021.1978490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Intravenous contrast media (CM) is often used in clinical practice to enhance CT scan imaging. For many years, contrast-induced nephropathy (CIN) was thought to be a common occurrence and to result in dire consequences. When treating patients with abnormal renal function, it is not unusual that clinicians postpone, cancel, or replace contrast-enhanced imaging with other, perhaps less informative tests. New studies however have challenged this paradigm and the true risk attributable to intravenous CM for the occurrence of CIN has become debatable. In this article, we review the latest relevant medical literature and aim to provide an evidence-based answer to questions surrounding the risk, outcomes, and potential mitigation strategies of CIN after intravenous CM administration.
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Affiliation(s)
- Jean-Sebastien Rachoin
- Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA.,Division of Hospital Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Yanika Wolfe
- Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Sharad Patel
- Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Elizabeth Cerceo
- Division of Hospital Medicine, Cooper University Health Care, Camden, NJ, USA
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27
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Yan X, Zhu Y, Wang X, Li Z. A case of acute renal injury and renal artery stenosis caused by cholesterol crystal embolization after coronary stenting: Improved by a combination therapy. Chronic Dis Transl Med 2021; 7:206-210. [PMID: 34505021 PMCID: PMC8413122 DOI: 10.1016/j.cdtm.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Xiaohui Yan
- Center of Nephropathy and Hemodialysis, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China
| | - Yanting Zhu
- Center of Nephropathy and Hemodialysis, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China
| | - Xiaoming Wang
- Center of Nephropathy and Hemodialysis, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China
| | - Zhenjiang Li
- Center of Nephropathy and Hemodialysis, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China
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28
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Cholesterol Embolization Syndrome After Kidney Transplantation: A Case Series and Systematic Review. Transplant Direct 2021; 7:e717. [PMID: 34476296 PMCID: PMC8384396 DOI: 10.1097/txd.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. Cholesterol embolization syndrome (CES) is an uncommon but well-known cause of renal failure in native kidneys, but little is known about CES in kidney transplant recipients. The aim of this study was to determine the incidence, clinical characteristics, histopathology, and prognosis of CES after kidney transplantation. Methods. CES cases in both transplanted and native kidneys (control group) were identified by searching the databases of the divisions of Nephrology and Pathology of our institution. Clinical data were retrospectively collected. Biopsies were classified according to the latest Banff 2019 Update. Second, a systematic literature search was performed (December 01, 2020) of Ovid MEDLINE, EMBASE, the Cochrane Central Register of controlled trials, Google Scholar, and Web of Science. Results. CES was observed in for-cause biopsies of 11 out of 2350 (0.47%) kidney transplant recipients transplanted between January 1, 2006, and December 31, 2018 (0.0009 cases per person-year). All patients had ≥1 cardiovascular risk factor, and 9 donors were expanded criteria donors. Graft loss occurred in 27.3% of the patients diagnosed with CES. Eight transplant biopsies with CES were also classified as biopsy-proven acute rejection. Transplant biopsies showed signs of inflammation (arteritis, n = 7; interstitial inflammation, n = 5; tubulitis, n = 7). One patient with CES in a native kidney was identified. The biopsy of the native kidney only showed arteritis and classified as an isolated “v” lesion. The literature search resulted in 188 unique articles of which 20 were included. A total of 47 cases of CES after kidney transplantation was reported. Cholesterol emboli were found in <1% of all kidney transplant biopsies. In 57.8% of the kidney transplant biopsies with CES described in literature, concomitant inflammation was present. Conclusions. CES is an uncommon cause of kidney transplant failure, although the incidence of CES may be underestimated. CES may mimic rejection as it can be accompanied by arteritis.
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Ishiyama K, Sato T. Efficacy of LDL apheresis for the treatment of cholesterol crystal embolism: A prospective, controlled study. Ther Apher Dial 2021; 26:456-464. [PMID: 34216189 DOI: 10.1111/1744-9987.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
This study was performed to evaluate the efficacy and safety of LDL apheresis (LDL-A) for the treatment of cholesterol crystal embolism (CCE) after cardiovascular procedures. We conducted a prospective multicenter study of 34 patients with CCE and 15 historical control patients. The present participants underwent six sessions of LDL-A for 4 weeks and underwent medical therapy with corticosteroids and statins. The mean creatinine concentration and estimated glomerular filtration rate at baseline were 3.82 ± 2.29 mg/dL and 17.8 ± 9.9 mL/min/1.73 m2 , respectively. The prevalence of maintenance dialysis at 24 weeks was significantly lower in the present participants than in the historical controls (3.1% vs. 40.0%, respectively; p < 0.0001), but the mortality rate at 24 weeks was comparable (19% vs. 33%, respectively). Although 45 adverse events occurred in 23 participants, there were no unexpected adverse events. LDL-A for CCE reduces the prevalence of maintenance dialysis 24 weeks later and is well tolerated. This study was registered in the Japan Registry of Clinical Trials (jRCTs022180029) and clinicaltrials.gov (NCT01726868).
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Affiliation(s)
- Katsuya Ishiyama
- Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Miyagi, Japan.,Department of Comprehensive Medicine for Kidney Disease-related Disorders, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Faculty of Medicines, Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Toshinobu Sato
- Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Miyagi, Japan.,Department of Comprehensive Medicine for Kidney Disease-related Disorders, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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30
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Harnessing the Physiological Functions of Cellular Prion Protein in the Kidneys: Applications for Treating Renal Diseases. Biomolecules 2021; 11:biom11060784. [PMID: 34067472 PMCID: PMC8224798 DOI: 10.3390/biom11060784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022] Open
Abstract
A cellular prion protein (PrPC) is a ubiquitous cell surface glycoprotein, and its physiological functions have been receiving increased attention. Endogenous PrPC is present in various kidney tissues and undergoes glomerular filtration. In prion diseases, abnormal prion proteins are found to accumulate in renal tissues and filtered into urine. Urinary prion protein could serve as a diagnostic biomarker. PrPC plays a role in cellular signaling pathways, reno-protective effects, and kidney iron uptake. PrPC signaling affects mitochondrial function via the ERK pathway and is affected by the regulatory influence of microRNAs, small molecules, and signaling proteins. Targeting PrPC in acute and chronic kidney disease could help improve iron homeostasis, ameliorate damage from ischemia/reperfusion injury, and enhance the efficacy of mesenchymal stem/stromal cell or extracellular vesicle-based therapeutic strategies. PrPC may also be under the influence of BMP/Smad signaling and affect the progression of TGF-β-related renal fibrosis. PrPC conveys TNF-α resistance in some renal cancers, and therefore, the coadministration of anti-PrPC antibodies improves chemotherapy. PrPC can be used to design antibody-drug conjugates, aptamer-drug conjugates, and customized tissue inhibitors of metalloproteinases to suppress cancer. With preclinical studies demonstrating promising results, further research on PrPC in the kidney may lead to innovative PrPC-based therapeutic strategies for renal disease.
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31
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Cavanna L, Zaffignani E, Citterio C, De Amicis S, Scarpioni R. A Rare Case of Coronavirus Disease 2019 Survival in an Elderly Patient With Atheroembolic Renal Disease. Cureus 2021; 13:e14201. [PMID: 33948397 PMCID: PMC8086762 DOI: 10.7759/cureus.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Atheroembolic renal disease (AERD) is a life-threatening illness. Coronavirus disease 2019 (COVID-19) has a high mortality rate in older patients with comorbidities. We report the case of severe-type COVID-19 in an 82-year-old female with AERD. She was treated with hydroxychloroquine-based therapy and overcame COVID-19. To our knowledge, this is the first report of a patient with AERD and COVID-19 pneumonia who overcame the infection and remains alive and well nine months following infection.
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Affiliation(s)
| | | | | | - Sara De Amicis
- Nephrology and Dialysis, Hospital Piacenza, Piacenza, ITA
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32
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Anders HJ, Wilkens L, Schraml B, Marschner J. One concept does not fit all: the immune system in different forms of acute kidney injury. Nephrol Dial Transplant 2021; 36:29-38. [PMID: 32337558 DOI: 10.1093/ndt/gfaa056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 02/06/2023] Open
Abstract
Renal and immune systems maintain body homoeostasis during physiological fluctuations and following tissue injury. The immune system plays a central role during acute kidney injury (AKI), adapting evolutional systems programmed for host defence and minimizing unnecessary collateral damage. Indeed, depending upon the disease context, the impact of the immune system upon the manifestations and consequences of AKI can be quite different. Here we provide an overview of the known and unknown involvement of the immune system within the wide range of different forms of AKI, to oppose oversimplification and to endorse deeper insights into the pathogenesis of the different diseases causing kidney injury. This approach may help to overcome some of the current hurdles in translational AKI research and the development of specific treatments for the different diseases, all presenting with an acute increase in serum creatinine or decline in urinary output. One concept does not fit all.
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Affiliation(s)
- Hans-Joachim Anders
- Department of Medicine IV, Renal Division, University Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Louise Wilkens
- Department of Medicine IV, Renal Division, University Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Barbara Schraml
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Planegg-Martinsried, Germany.,Faculty of Medicine, Institute for Cardiovascular Physiology and Pathophysiology, Biomedical Center, LMU Munich, Planegg-Martinsried, Germany
| | - Julian Marschner
- Department of Medicine IV, Renal Division, University Hospital of the Ludwig Maximilians University, Munich, Germany
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33
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Sato Y, Okamoto K, Fukuda M, Oyama Y, Kondo Y, Nishida H, Daa T, Togo K, Sonoda A, Fukuda K, Matsunari O, Ogawa R, Honda K, Mizukami K, Okimoto T, Kodama M, Murakami K. An Autopsy Case of Acute Pancreatitis Caused by Cholesterol Crystal Embolization. Intern Med 2021; 60:839-845. [PMID: 33055480 PMCID: PMC8024961 DOI: 10.2169/internalmedicine.5524-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cholesterol crystal embolization (CCE) shows a poor prognosis and it can cause ischemic organ damage due to a cholesterol embolism from atherosclerotic lesions in large blood vessels. Such an embolism mainly affects the kidneys and skin, although cases involving digestive organs have also been reported. We encountered an autopsy case of CCE with damage mainly to the digestive organs, including the pancreas. The patient had non-specific abdominal symptoms or image findings. Symptomatic therapy failed to save him. CCE can involve the digestive organs, and so must be differentiated from abdominal pathologies. Moreover, conventional treatments may be ineffective, and new treatments might thus be necessary.
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Affiliation(s)
- Yuto Sato
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Kazuhisa Okamoto
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Masahide Fukuda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Yuzo Oyama
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Japan
| | - Yoshihiko Kondo
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Japan
| | - Kazumi Togo
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Akira Sonoda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Kensuke Fukuda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Osamu Matsunari
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Ryo Ogawa
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Koichi Honda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Tadayoshi Okimoto
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Masaaki Kodama
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
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34
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Ștefan G, Zugravu A, Stancu S, Gherghiceanu M, Terinte‐Balcan G. Atheroembolic kidney disease: The under-recognized silent killer. Clin Case Rep 2021; 9:1824-1825. [PMID: 33768956 PMCID: PMC7981600 DOI: 10.1002/ccr3.3874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/11/2022] Open
Abstract
While kidney biopsy demonstrating cholesterol crystal emboli is the method of definitive diagnosis; the triad of acute to subacute renal failure with skin findings in the setting of recent precipitating event should raise clinical suspicion for atheroembolic kidney disease.
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Affiliation(s)
- Gabriel Ștefan
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Adrian Zugravu
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Simona Stancu
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Mihaela Gherghiceanu
- Department of Cell Biology and Histology“Carol Davila” University of Medicine and PharmacyBucharestRomania
- Ultrastructural Pathology“Victor Babes” National Institute of PathologyBucharestRomania
| | - George Terinte‐Balcan
- Ultrastructural Pathology“Victor Babes” National Institute of PathologyBucharestRomania
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35
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Hamura R, Haruki K, Iwase R, Furukawa K, Shirai Y, Onda S, Gocho T, Ikegami T. Ischemic small bowel perforation caused by cholesterol crystal embolism following transcatheter arterial chemoembolization for recurrent hepatocellular carcinoma: a case report. Surg Case Rep 2021; 7:45. [PMID: 33566211 PMCID: PMC7876172 DOI: 10.1186/s40792-021-01116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Cholesterol crystal embolism (CCE) following transcatheter arterial chemoembolization (TACE) is rare. Case presentation A 71-year-old man underwent TACE for recurrence of hepatocellular carcinoma (HCC). On postoperative day (POD) 5, he developed abdominal pain and fever. Computed tomography revealed intraperitoneal free air. The patient was diagnosed with gastrointestinal perforation with peritonitis, for which partial intestinal resection and covering ileostomy were performed. Histological examination revealed perforation of the small intestine caused by CCE. The patient made a satisfactory recovery and was discharged on POD 30. The patient showed no recurrence of cholesterol crystal embolism or HCC for 2 years after surgery. Conclusion We reported a successfully treated case of ischemic small bowel perforation due to cholesterol crystal embolism following transcatheter arterial chemoembolization for recurrent HCC.
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Affiliation(s)
- Ryoga Hamura
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Koichiro Haruki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryota Iwase
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Shirai
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Ikegami
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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36
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Kakeshita K, Koike T, Imamura T, Arisawa Y, Murai S, Shimizu A, Kiyosawa T, Yamazaki H, Kinugawa K. Cholesterol embolization syndrome and intra-abdominal bleeding immediately after initiation of hemodialysis: a case report with literature review. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cholesterol embolization syndrome (CES) is a disease associating with the systemic cholesterol crystal embolism and end-organ dysfunction due to the atherosclerotic plaque rupture, which is dominantly triggered by the intravascular intervention. There is no consensus for which types of anticoagulants we should use during the hemodialysis in patients with CES and end-stage renal disease.
Case presentation
We had a 68-year-old man with CES due to intravascular intervention, who suffered the omental bleeding, instead of the embolism, immediately after the initiation of hemodialysis with heparinization. An emergent laparotomy found active bleeding from the omentum, which was surgically repaired. The histopathological analysis showed the embolization of cholesterol crystal clefts in the omentum artery and the injury of arterial wall structure accompanied by the infiltration of inflammatory cells. We preferred nafamostat mesylate during hemodialysis and he had no adverse events following the surgery.
Conclusions
It should be noticed that, in addition to the embolic events, bleeding events can develop in patients with CES, particularly following the initiation of hemodialysis with anticoagulation therapy.
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37
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the use of iodinated contrast media in patients with kidney disease 2018. Clin Exp Nephrol 2020; 24:1-44. [PMID: 31709463 PMCID: PMC6949208 DOI: 10.1007/s10157-019-01750-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiromitsu Hayashi
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazutaka Aonuma
- Cardiology Department, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Fujigaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Taichi Sato
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Toei
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryusuke Murakami
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadateru Takayama
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiro Komatsu
- Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Yugo Ito
- Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Ryo Miyazawa
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Tomonari Ogawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Eri Koshi
- Department of Nephrology, Komaki City Hospital, Aichi, Japan
| | - Tomoki Kosugi
- Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
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38
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Morino J, Hirai K, Kaneko S, Minato S, Yanai K, Mutsuyoshi Y, Ishii H, Matsuyama M, Kitano T, Shindo M, Aomatsu A, Miyazawa H, Ito K, Ueda Y, Ookawara S, Morishita Y. Successful treatment of cholesterol crystal embolism with anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) antibody: a case report. Ren Fail 2020; 42:173-178. [PMID: 32046605 PMCID: PMC7034108 DOI: 10.1080/0886022x.2020.1726383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background We report a unique case of renal cholesterol crystal embolism (CCE) induced by carotid artery stenting that was successfully treated with evolocumab, a fully human monoclonal antibody against proprotein convertase subtilisin kexin type 9 (PCSK9). Case presentation A 77-year-old man with hypertension, hyperlipidemia, and chronic kidney disease was referred to our department for decreased estimated glomerular filtration rate (eGFR)—from 32.0 to 13.9 mL/min/1.73 m2—5 weeks after carotid artery stenting. Further examination revealed livedo reticularis in the bilateral toes and eosinophilia (723/μL). Skin biopsy from livedo reticularis tissue in the bilateral toes showed cholesterol clefts in the small arteries. The patient was therefore diagnosed with CCE. After 25 weeks’ administration of evolocumab at a dose of 140 mg subcutaneously administered every 2 weeks, his eGFR had improved from 10.7 to 18.1 mL/min/1.73 m2. Conclusion Evolocumab may have a beneficial effect on renal involvement in patients with CCE.
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Affiliation(s)
- Junki Morino
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shohei Kaneko
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Saori Minato
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Katsunori Yanai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Mutsuyoshi
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroki Ishii
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Momoko Matsuyama
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taisuke Kitano
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsutoshi Shindo
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akinori Aomatsu
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Shintani T, Mitsuoka H, Hasegawa Y, Hayashi M, Natsume K, Ookura K, Sato Y, Obara H. Effect of Atheromatous Aorta on Thromboembolic Complications after Endovascular Aortic Aneurysm. Ann Vasc Dis 2020; 13:273-280. [PMID: 33384730 PMCID: PMC7751071 DOI: 10.3400/avd.oa.20-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the effect of atheromatous aorta on thromboembolic complications after endovascular aortic aneurysm repair (EVAR) and to assess the risk factors for these complications. Materials and Methods: This retrospective study included patients who underwent EVAR for an abdominal aortic aneurysm at the Shizuoka Red Cross Hospital from 2007 to 2018. We defined atheromatous aorta as a thoracic shaggy aorta or abdominal aorta with neck thrombus. The main outcome was renal dysfunction and peripheral embolization (thromboembolic complications). We compared the incidence of thromboembolic complications between patients with normal aorta and atheromatous aorta. Moreover, we assessed the risk factors associated with thromboembolic complications in patients with atheromatous aorta. Results: Patients with atheromatous aorta had significantly more thromboembolic complications, such as renal dysfunction (24.5% vs. 3.9%; P<0.001) and peripheral embolization (12.3% vs. 0.0%; P<0.001) than those with normal aorta, respectively. We identified no risk factors associated with thromboembolic complications in patients with atheromatous aorta. Conclusion: Atheromatous aorta increases the risk of thromboembolic complications after EVAR. However, there is no established therapy for these thromboembolic complications. Further studies are necessary to determine the appropriate therapy, including appropriate preoperative medication, to prevent these complications.
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Affiliation(s)
| | | | - Yuto Hasegawa
- Department of Cardiac Surgery, Shizuoka Red Cross Hospital
| | | | - Kayoko Natsume
- Department of Vascular Surgery, Shizuoka Red Cross Hospital
| | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
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Tanaka H, Yamana H, Matsui H, Fushimi K, Yasunaga H. Proportion and risk factors of cholesterol crystal embolization after cardiovascular procedures: a retrospective national database study. Heart Vessels 2020; 35:1250-1255. [PMID: 32277287 DOI: 10.1007/s00380-020-01593-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/27/2020] [Indexed: 01/30/2023]
Abstract
Cholesterol crystal embolization (CCE) is a rare, mainly iatrogenic condition. The proportion of CCE after cardiovascular procedures has not been fully elucidated. The purpose of this study was to determine the proportion of CCE diagnosed after cardiovascular procedures and to identify risk factors for CCE occurrence. Data on patients aged older than 40 years who underwent cardiovascular procedures between July 2010 and March 2017 were extracted from the Japanese Diagnosis Procedure Combination database. Inpatients diagnosed with CCE within 1 year after procedures in the same hospital were identified. Logistic regression analysis was performed to identify factors associated with the occurrence of CCE. There were 962 patients with CCE in 2,190,300 patients who underwent cardiovascular procedures. The overall proportion of CCE after cardiovascular procedures was 4.4 per 10,000 patients (95% confidence interval 4.1-4.7). The overall in-hospital mortality among patients with CCE was 11% (107/962). Older age, male sex, smoking, heart failure, peripheral vascular disease, cerebrovascular disease, renal insufficiency, diabetes mellitus, hypertension, and aortic aneurism and dissection were significantly associated with the higher occurrence of CCE. Compared with cardioangiography, several procedures were significantly associated with higher occurrence of CCE, including intra-aortic balloon pumping, percutaneous transluminal angioplasty of the renal artery, and transcatheter aortic valve implantation or balloon aortic valvuloplasty. CCE is rare but remains a severe complication of cardiovascular procedures. Atherosclerotic risk factors and certain cardiovascular procedures were associated with CCE.
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Affiliation(s)
- Hiroyuki Tanaka
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Nephrology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Association between eosinophilia and renal prognosis in patients with pathologically proven cholesterol crystal embolism. Clin Exp Nephrol 2020; 24:680-687. [PMID: 32266635 PMCID: PMC7371646 DOI: 10.1007/s10157-020-01886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Background Approximately, 20–70% of patients with cholesterol crystal embolism (CCE) have eosinophilia. However, it remains unknown how eosinophilia influences renal prognosis in patients with CCE. In this study, we investigated the association between eosinophil count (Eo) and renal prognosis in CCE patients on steroid therapy. Methods The present study is a single-centered retrospective cohort study in patients with renal dysfunction and CCE from April 2007 to May 2018. This study included the patients who were treated with neither maintenance dialysis nor steroid before CCE diagnosis, and followed-up for kidney function until November 2019. We assessed whether eosinophilia at the time of CCE diagnosis was related to renal death after treating with steroid therapy. Results Thirty patients with pathologically diagnosed CCE were enrolled and followed-up for 11.0 (5.2–43.4) months. There were significant differences in the white blood cell count (p = 0.01), hemoglobin (p = 0.009), serum creatinine levels (p = 0.008), phosphate (p = 0.049), and Eo (p = 0.008) between the renal survival and renal death groups. Using the receiver operating characteristic curve analysis with Youden index, Eo of 810/µL showed 100% sensitivity and 69.6% specificity for detecting renal death (area under the curve: 0.839). Comparing the outcomes in patients having Eo ≥ and < 810/µL using the log-rank test, there is a significantly higher renal death rate in CCE patients with Eo ≥ 810/µL (p = 0.0016). Conclusion Higher eosinophilia was a prognostic risk factor for renal death in the patients with CCE.
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Incidence, risk factors and prognostic impact of acute kidney injury after coronary angiography and intervention in kidney transplant recipients: a single-center retrospective analysis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:58-64. [PMID: 32368237 PMCID: PMC7189128 DOI: 10.5114/aic.2020.93913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Kidney transplant recipients (KTR) represent a high-risk population for cardiovascular disease. Coronary artery disease (CAD) is the most common cause of morbidity and mortality in this population. In KTR, coronary angiography and intervention (CI) can be associated with the risk of acute kidney injury (AKI). Aim Data about the incidence and impact of AKI after CI in this population are rare. The aim of the present study is to describe the incidence and risk factors of AKI, periprocedural bleeding and the prognostic impact on 1-year mortality in KTR undergoing CI. Material and methods This retrospective single-center study includes all KTR undergoing CI at University Hospital Frankfurt between 2005 and 2015. Results A total of 135 CIs in KTR were analyzed. AKI occurred in 31 of 135 CIs (23%, AKI group). Patients of the AKI group were older; other baseline characteristics did not show significant differences. The amount of contrast dye used was higher in the AKI group (p = NS). Periprocedural bleeding defined by BARC criteria occurred more often in the AKI group (23% vs. 5%, p < 0.01) and persisted as a risk factor of AKI in multivariate analysis (odds ratio = 6.43, 95% CI: 1.78–23.20, p = 0.01). In-hospital mortality was 3% in the AKI group; no patient of the non-AKI group died during hospitalization (p = 0.2). One-year-survival was significantly higher in the non-AKI group (94% vs. 81%, p = 0.02). Conclusions AKI is an important prognostic determinant in KTR undergoing coronary angiography and percutaneous coronary intervention (PCI). Periprocedural bleeding events were associated with AKI. Well-known risk factors for AKI such as contrast agent and diabetes were of minor impact.
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Urotensin receptor antagonist urantide improves atherosclerosis-related kidney injury by inhibiting JAK2/STAT3 signaling pathway in rats. Life Sci 2020; 247:117421. [DOI: 10.1016/j.lfs.2020.117421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
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Dumas M, Flipo R, Blum L, Jouzel C, Brochériou I, Begon E. [Cholesterol crystal embolism mimicking a DRESS]. Rev Med Interne 2020; 41:275-278. [PMID: 32089328 DOI: 10.1016/j.revmed.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Clinical presentation of cholesterol crystal embolism (CCE) can be dermatologic when cholesterol crystals become lodged in small cutaneous arteries resulting in ischemia. We report a case of CCE with erythroderma misleading to a diagnostic of drug reaction with eosinophilia and systemic symptoms (DRESS). CASE REPORT A 66 year-old woman presented with erythroderma few months after initiation of allopurinol. Acute renal failure was present with elevation in plasma creatinine concentration (523μmol/L) and hypereosinophilia (HE) (5666/mm3). Finally, the REGISCAR score helped to rule out DRESS diagnostic. Past blood-count tests were analyzed revealing chronic HE present before allopurinol initiation. Renal biopsy identified CCE. CONCLUSION This case is the first to report a DRESS like presentation of CCE. Clinical findings are secondary to HE and not to occlusion of cutaneous arteries.
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Affiliation(s)
- M Dumas
- Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France.
| | - R Flipo
- Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France
| | - L Blum
- Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France
| | - C Jouzel
- Service de néphrologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France
| | - I Brochériou
- Service d'anatomie et cytologie pathologiques, hôpital universitaire Pitié-Salpêtrière, Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - E Begon
- Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France
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Shibata J, Yoshihara M, Kato T. Gastric remnant necrosis secondary to cholesterol crystal embolization after distal gastrectomy in a gastric cancer patient: a case report. BMC Surg 2020; 20:54. [PMID: 32192489 PMCID: PMC7082983 DOI: 10.1186/s12893-020-00716-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Distal gastrectomy with lymph node dissection, a standard operative technique for gastric cancer treatment, is safely performed because the stomach has a rich vascular supply. Gastric remnant necrosis caused by cholesterol crystal embolization following distal gastrectomy has not been described previously. We report a case of gastric remnant necrosis in a patient with cholesterol crystal embolization. Case presentation A 70-year-old man with a history of cholesterol crystal embolization presented to our surgery department with complaints of anorexia and dysphasia. He was diagnosed with gastric cancer invading the pyloric antrum and underwent distal gastrectomy with Billroth 2 reconstruction. On postoperative day 11, he developed abdominal pain without fever. Emergency laparotomy revealed that most parts of the remnant stomach were necrosed. Total gastrectomy with Roux-en-Y reconstruction and abscess drainage were performed. After surgery, anastomotic leakage occurred and was treated conservatively. However, the superior pancreaticoduodenal artery aneurysm suddenly ruptured and he expired. Conclusions Gastric remnant necrosis after distal gastrectomy can be a gastrointestinal presentation of cholesterol crystal embolization. Perioperative/intraoperative risk assessments such as preventive total gastrectomy or intraoperative assessment with indocyanine green fluorescence angiography may be desirable to avoid this complication.
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Affiliation(s)
- Jumpei Shibata
- Department of General Surgery, Toyohashi Municipal Hospital, 441-8570, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan.
| | - Motoi Yoshihara
- Department of General Surgery, Toyohashi Municipal Hospital, 441-8570, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Takehito Kato
- Department of General Surgery, Toyohashi Municipal Hospital, 441-8570, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
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Corradetti V, Comai G, Ravaioli M, Cuna V, Aiello V, Odaldi F, Angeletti A, Capelli I, La Manna G. Iloprost in Acute Post-kidney Transplant Atheroembolism: A Case Report of Two Successful Treatments. Front Med (Lausanne) 2020; 7:41. [PMID: 32181252 PMCID: PMC7059607 DOI: 10.3389/fmed.2020.00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
Cholesterol embolization (CE) is a rare and alarming post-transplant complication, responsible for primary non-function (PNF) or delayed graft function (DGF). Its incidence is expected to rise due to increasingly old donors and recipients and the extended criteria for donation. Therapy with statins and steroids has not been shown to be effective, while agonism of prostaglandin I2 has been reported to be useful in systemic CE. We report two cases of acute post-transplant CE in which intravenous iloprost (0.05 mg/kg/day) was added to standard statin and steroid therapy. In the first instance, CE was due to embolization from the kidney artery resulting in embolization of the small vessels; after a long DGF and 15 days of iloprost therapy, renal function recovered. The second instance is a case of embolization from the iliac artery of the recipient, where CE manifested as a partial renal infarction. After 5 days of iloprost administration, creatinine levels improved. Iloprost acts on vasodilation and on different inflammatory pathways, improving the anti-inflammatory profile. Post-transplant CE is difficult to diagnose and, if not treated, can lead to loss of function. Iloprost added to standard therapy could be beneficial in accelerating renal function recovery immediately after transplant.
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Affiliation(s)
- Valeria Corradetti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Unit of General and Transplant Surgery, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Federica Odaldi
- Unit of General and Transplant Surgery, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola Malpighi Hospital Bologna, Bologna, Italy
| | - Andrea Angeletti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
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Shi C, Kim T, Steiger S, Mulay SR, Klinkhammer BM, Bäuerle T, Melica ME, Romagnani P, Möckel D, Baues M, Yang L, Brouns SLN, Heemskerk JWM, Braun A, Lammers T, Boor P, Anders HJ. Crystal Clots as Therapeutic Target in Cholesterol Crystal Embolism. Circ Res 2020; 126:e37-e52. [PMID: 32089086 DOI: 10.1161/circresaha.119.315625] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
RATIONALE Cholesterol crystal embolism can be a life-threatening complication of advanced atherosclerosis. Pathophysiology and molecular targets for treatment are largely unknown. OBJECTIVE We aimed to develop a new animal model of cholesterol crystal embolism to dissect the molecular mechanisms of cholesterol crystal (CC)-driven arterial occlusion, tissue infarction, and organ failure. METHODS AND RESULTS C57BL/6J mice were injected with CC into the left kidney artery. Primary end point was glomerular filtration rate (GFR). CC caused crystal clots occluding intrarenal arteries and a dose-dependent drop in GFR, followed by GFR recovery within 4 weeks, that is, acute kidney disease. In contrast, the extent of kidney infarction was more variable. Blocking necroptosis using mixed lineage kinase domain-like deficient mice or necrostatin-1s treatment protected from kidney infarction but not from GFR loss because arterial obstructions persisted, identifying crystal clots as a primary target to prevent organ failure. CC involved platelets, neutrophils, fibrin, and extracellular DNA. Neutrophil depletion or inhibition of the release of neutrophil extracellular traps had little effects, but platelet P2Y12 receptor antagonism with clopidogrel, fibrinolysis with urokinase, or DNA digestion with recombinant DNase I all prevented arterial occlusions, GFR loss, and kidney infarction. The window-of-opportunity was <3 hours after CC injection. However, combining Nec-1s (necrostatin-1s) prophylaxis given 1 hour before and DNase I 3 hours after CC injection completely prevented kidney failure and infarcts. In vitro, CC did not directly induce plasmatic coagulation but induced neutrophil extracellular trap formation and DNA release mainly from kidney endothelial cells, neutrophils, and few from platelets. CC induced ATP release from aggregating platelets, which increased fibrin formation in a DNase-dependent manner. CONCLUSIONS CC embolism causes arterial obstructions and organ failure via the formation of crystal clots with fibrin, platelets, and extracellular DNA as critical components. Therefore, our model enables to unravel the pathogenesis of the CC embolism syndrome as a basis for both prophylaxis and targeted therapy.
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Affiliation(s)
- Chongxu Shi
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Tehyung Kim
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Stefanie Steiger
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Shrikant R Mulay
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Barbara M Klinkhammer
- Department of Nephrology, Institute of Pathology (B.M.K, P.B.), RWTH Aachen University Hospital, Germany
| | - Tobias Bäuerle
- Preclinical Imaging Platform Erlangen, Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany (T.B.)
| | - Maria Elena Melica
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (M.E.M., P.R.), University of Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio" (M.E.M., P.R.), University of Florence, Italy
| | - Paola Romagnani
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (M.E.M., P.R.), University of Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio" (M.E.M., P.R.), University of Florence, Italy.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy (P.R.)
| | - Diana Möckel
- Institute for Experimental Molecular Imaging (D.M., M.B., T.L.), RWTH Aachen University Hospital, Germany
| | - Maike Baues
- Institute for Experimental Molecular Imaging (D.M., M.B., T.L.), RWTH Aachen University Hospital, Germany
| | - Luying Yang
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Sanne L N Brouns
- Department of Biochemistry, CARIM, Maastricht University, The Netherlands (S.L.N.B., J.W.M.H.)
| | - Johan W M Heemskerk
- Department of Biochemistry, CARIM, Maastricht University, The Netherlands (S.L.N.B., J.W.M.H.)
| | - Attila Braun
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians University Munich, German Center for Lung Research, Germany (A.B.)
| | - Twan Lammers
- Institute for Experimental Molecular Imaging (D.M., M.B., T.L.), RWTH Aachen University Hospital, Germany
| | - Peter Boor
- Department of Nephrology, Institute of Pathology (B.M.K, P.B.), RWTH Aachen University Hospital, Germany
| | - Hans-Joachim Anders
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
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Denis Le Seve J, Gourraud Vercel C, Connault J, Artifoni M. [Update on cholesterol crystal embolism]. Rev Med Interne 2020; 41:250-257. [PMID: 32088097 DOI: 10.1016/j.revmed.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 12/19/2019] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
Cholesterol crystal embolism is a systemic pathology associated with diffuse atherosclerosis. Pathophysiology corresponds to tissue necro-inflammation secondary to arteriolar occlusion associated with microembolism from atherosclerotic plaques of large diameter arteries. The clinical presentation is heterogeneous and polymorphic. Multiple organs may be the targets, but preferential damage is skin, kidneys and digestive system. It is a serious pathology, underdiagnosed, with a poor prognosis. The risk factors for developing the disease remain the same risk factors as atheroma. The factors favouring migration of microembolism remain mainly vascular interventional procedures; easy to diagnose, they oppose spontaneous embolic migrations or secondary to the introduction of antithrombotic treatment, whose diagnosis is more difficult and the prognosis more severe. The diagnosis of the disease remains mostly a diagnosis of elimination and often refers to a bundle of clinical, biological, morphological and histologic arguments. The treatment is poorly codified and the subject of few publications. It will favour both symptomatic treatment (and mainly that of pain) and complications (high blood pressure, renal insufficiency). The aetiological support remains less consensual. The treatment of atherosclerotic plaques consists, of course, in the correction of classical cardiovascular risk factors, the introduction of a statin. It will be discussed in the implementation of surgery or angioplasty to exclude potentially responsible atherosclerotic lesions. Eviction of antithrombotic therapy should be considered in terms of the benefit-risk balance, but often in favour of maintaining it. Finally, other treatments may be proposed in a case-by-case basis, such as oral or intravenous corticosteroid therapy, colchicine or LDL aphaeresis.
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Affiliation(s)
- J Denis Le Seve
- Service de médecine interne-vasculaire, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - C Gourraud Vercel
- Service de néphrologie et immunologie clinique, centre hospitalier universitaire de Nantes, 30, boulevard Jean-Monnet, immeuble Jean-Monnet, 44093 Nantes cedex 1, France
| | - J Connault
- Service de médecine interne-vasculaire, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - M Artifoni
- Service de médecine interne-vasculaire, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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Khoury MK, Timaran DE, Soto-Gonzalez M, Timaran CH. Fenestrated-branched endovascular aortic repair in patients with chronic kidney disease. J Vasc Surg 2020; 72:66-72. [PMID: 32063447 DOI: 10.1016/j.jvs.2019.09.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Renal function impairment is a common complication after open repair of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). The purpose of this study was to assess renal perioperative outcomes and renal function deterioration after fenestrated-branched endovascular aneurysm repair (F/BEVAR) in patients with chronic kidney disease (CKD). METHODS The study included 186 patients who underwent F/BEVAR between 2013 and 2018 for suprarenal, juxtarenal, and type I to type IV TAAAs. Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) study equation. Postoperative acute kidney injury (AKI) and CKD were defined using RIFLE criteria (Risk, Injury, Failure, Loss, and End-stage renal disease) and CKD staging system (stage ≥3, GFR <60 mL/min/1.73 m2), respectively. For those without baseline CKD, renal decline was defined as a drop in GFR <60 mL/min/1.73 m2 (ie, progression to CKD stage 3 or higher). For patients with baseline renal dysfunction, GFR decline ≥20% or progression in CKD stage (ie, from stage 3 to stage 4) was considered renal decline. RESULTS CKD was present in 83 patients (44.6%). Postoperative AKI was diagnosed in 27 patients (14.5%); 13 (48.1%) had history of CKD and 14 (51.9%) had adequate renal function preoperatively (P = .8). None of these patients required permanent renal replacement therapy. Intraoperative technical success was 100%. Overall 30-day mortality was 1.1%. There was no difference in 30-day mortality in patients with (1.2%) and without (1.0%) CKD (P = .5). During a median follow-up time of 12 months (interquartile range, 6-23 months), renal decline was observed in 21 patients (25.3%) with previous CKD and in 11 patients (10.6%) without CKD (P = .01). Among patients with previous CKD, 18 patients (9%) progressed from stage 3 CKD to stage 4. In patients with progression in CKD stage, two (5%) had renal stent stenosis requiring restenting. Among patients with renal decline, 13 had juxtarenal aneurysms (21.3%), 27 had suprarenal aneurysms (44.3%), and 21 had TAAAs (34.3%; P = .4). Subset analysis of patients who developed AKI in the immediate postoperative period found that patients with a history of CKD were less likely to experience freedom from renal decline. CONCLUSIONS F/BEVAR is an effective and safe procedure for patients with complex abdominal aortic aneurysms and TAAAs, even among patients with CKD. The frequency of AKI was not affected by pre-existing CKD. Midterm outcomes demonstrated that progression of CKD was more frequent among patients with pre-existing CKD, but permanent renal replacement therapy was not required. Anatomic extent of aneurysms did not affect CKD progression. CKD patients are susceptible to renal decline over time if they experience AKI in the postoperative period. Therefore, preventing AKI in the postoperative period should be regarded as a priority. Long-term effects of CKD after F/BEVAR remain to be elucidated.
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Affiliation(s)
- Mitri K Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - David E Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Marilisa Soto-Gonzalez
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex.
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Singh N, Gupta A, Kaur G. Atheroembolic renal disease. Indian J Nephrol 2020; 30:1-2. [PMID: 32015591 PMCID: PMC6977374 DOI: 10.4103/ijn.ijn_382_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/16/2019] [Accepted: 03/09/2019] [Indexed: 11/17/2022] Open
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