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Monday, February 18, 2008

Atheroembolic renal disease

Definition:

Atheroembolic renal disease (AERD) is an inflammatory reaction in the small blood vessels of the kidneys.

Alternative Names:

Renal disease - atheroembolic; Cholesterol embolization syndrome; Atheroemboli - renal; Atherosclerotic disease - renal

Causes, incidence, and risk factors:

AERD is linked to atherosclerosis . Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard substances called plaque.
In AERD, cholesterol crystals from plaque break off and move to the kidneys and into the blood stream. Once in circulation, the crystals get stuck in tiny blood vessels called arterioles. There, they cause an intense inflammatory response. The result is organ damage due to decreased blood supply. Acute kidney failure is possible if the reaction is severe.
Atherosclerosis of the aorta is the most common cause of AERD. The cholesterol crystals may also break off during cardiac catheterization or aortic surgery.
In some cases, AERD may occur without a cause.
The risk factors for AERD are the same as risk factors for atherosclerosis.

Symptoms:

AERD may not cause any symptoms. Symptoms that may occur include:
  • Foot pain, ulcers on the feet, or “blue toes”
  • Pain in the abdomen, nausea, or vomiting
  • Pancreatitis or hepatitis (rare)
  • Strokes or blindness
  • Flank pain and blood in the urine (rare)
  • Uncontrolled high blood pressure
Kidney failure may result in the following:
  • Nausea or vomiting
  • Loss of appetite
  • Weight loss
  • Decreased or no urine output
  • Swelling
  • Decrease in sensation
  • Skin pigment changes
  • Dry itchy skin
  • Drowsiness, confusion, lethargy

Signs and tests:

The doctor will perform a physical exam. Swelling may affect the entire body. An eye exam may show particles in the small arteries of the retina .
The doctor will listen to your lungs and heart with a stethoscope. Abnormal sounds may be heard. For example, a loud whooshing sound called a bruit may be heard over the aorta or renal artery.
Blood pressure may be high. There may be multiple ulcers of the skin of the lower feet.
Tests that may be done include:
  • Abdominal CT scan
  • Abdominal MRI
  • Abdominal x-ray
  • Chem-7 or chem-20
  • Complete blood count
  • Kidney biopsy
  • Kidney function tests including BUN and creatinine
  • Kidney or abdominal ultrasound
  • Renal arteriography
  • Serum complement
  • Serum lipids
  • Urinalysis

Treatment:

Medicines may be used to treat high blood pressure and lower lipid and cholesterol levels.
Other treatments for kidney failure or complications may be needed.
Your doctor may tell you to reduce fats and cholesterol in your diet. If you have kidney failure, you may need to restrict protein, salt, and fluids, or make other dietary changes.
Your doctor may also recommend other lifestyle changes such as increased exercise or weight loss. Stopping smoking is extremely important.

Expectations (prognosis):

The outcome varies but is generally poor. The disorder slowly gets worse over time. Lifestyle changes may help slow progression of the disease.

Complications:

  • Acute renal failure
  • Chronic renal failure
  • High blood pressure
  • Blood clots to other location of the body -- brain, intestine, legs

Calling your health care provider:

Call your doctor if you have:
  • A decrease in urine output or no urine production
  • Blood in the urine
  • Severe abdominal pain or leg pain
  • Unexplained ulcers on your legs or feet
  • Toes that turn purple and occur with foot pain

Prevention:

You can alter the factors that increase your risk of getting this disease. You should lose weight if you are obese , decrease or stop smoking, and follow your doctor's recommendations to control diabetes or high blood pressure. Reducing fats, especially saturated fats, in your diet may help to reduce serum lipid levels.

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