Lipoprotein associated isoproteins in a patient with cholesterol emboli resulting in renal failure

Severe type III hyperlipoproteinemia in two patients maintained on chronic hemodialysis

Two patients with severe hyperlipidemia receiving long-term hemodialysis were classified as type III hyperlipoproteinemic subjects. They are homozygous for apolipoprotein E2 and have an elevated VLDL-cholesterol/plasma-triglyceride ratio. The dyslipoproteinemia was severely aggravated by the renal failure, but careful treatment with bezafibrate was able to effectively lower elevated serum lipids. Accurate diagnosis of lipid abnormalities in patients with chronic renal failure seems to be necessary to plan appropriate therapeutic interventions and to lower the risk for accelerated atherosclerosis.

Cholesterol crystal embolization: a review of 221 cases in the English literature

Cholesterol crystal embolization (CCE) frequently presents with nonspecific manifestations that mimic other systemic diseases. The authors reviewed 221 cases of histologically proven CCE in the English literature to define the clinical, laboratory, and pathologic characteristics of this disorder. CCE affected predominantly elderly males (mean age sixty-six) with a frequent history of hypertension (61%), atherosclerotic cardiovascular disease (44%), renal failure (34%), and aortic aneurysms (25%) at presentation. At least one possible predisposing factor was present in 31% and included operative and radiological vascular procedures and the use of anticoagulants. Cutaneous findings (34%) and renal failure (50%) were two of the most common clinical findings throughout the course of CCE. The nonspecific signs and symptoms included: fever (7%), weight loss (7%), myalgias (4%), and headache (3%). Premortem diagnoses were established in 31% of patients most commonly by biopsy of the muscle, skin, and kidney. Mortality was high (81%) and was most commonly due to multifactorial, cardiac, and renal etiologies. The authors conclude that CCE should be strongly considered in elderly patients with atherosclerotic vascular disease who have the onset of renal insufficiency and cutaneous manifestations. CCE may be confirmed by a skin or muscle biopsy.

Trauma, high density lipoproteins, and serum amyloid protein A

Several apoproteins not readily detectable in normal serum lipoproteins were found in markedly increased amounts in the lipoprotein density interval 1.125-1.21 g/ml (HDL3) of serum obtained from victims of severe trauma. Following electrophoretic separations, they were shown to be isotypes of the acute-phase protein serum amyloid A (SAA) by immunoreaction with antiserum to the structurally related tissue amyloid protein A (AA). The two principal apoSAA isotypes in the HDL3 of trauma patients appear to be identical to the two principal isotypes (apoSAA1 and apoSAA2) previously isolated from the HDL3 of pooled serum representing an unselected patient population. Concentrations of apolipoproteins A-I and A-II in the HDL3 of the trauma patients were significantly lower than in the HDL3 of normal serum. Evidence is presented that several recently described 'new' families of HDL apoproteins, all of an acute-phase nature, are SAA apoproteins, which are emerging as sensitive indicators of tissue damage.