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(Circulation. 2007;116:298-304.)
© 2007 American Heart Association, Inc.

Vascular Medicine

The Challenge of Diagnosing Atheroembolic Renal Disease

Clinical Features and Prognostic Factors

Francesco Scolari, MD; Pietro Ravani, MD; Rossella Gaggi, MD; Marisa Santostefano, MD; Cristiana Rollino, MD; Nevio Stabellini, MD; Loredana Colla, MD; Battista Fabio Viola, MD; Paolo Maiorca, MD; Chiara Venturelli, MD; Stefano Bonardelli, MD; Pompilio Faggiano, MD; Brendan J. Barrett, MD

From the Division of Nephrology, University and Spedali Civili, Brescia, Italy (F.S., V.B.F., M.P., C.V.); Clinical Epidemiology Unit, Memorial University of Newfoundland, Newfoundland, Canada (P.R., B.J.B.); Division of Nephrology, Istituti Ospedalieri, Cremona, Italy (P.R.); Division of Nephrology, Ospedale Malpighi, Bologna, Italy (R.G.); Division of Nephrology, Ospedale Civile, Ravenna, Italy (M.S.); Division of Nephrology, Ospedale San G. Bosco, Torino, Italy (C.R.); Division of Nephrology, Ospedale Civile, Ferrara, Italy (S.N.); Division of Nephrology, University and Ospedale Molinette, Torino, Italy (C.L.); Division of Surgery, University and Spedali Civili, Brescia, Italy (S.B.); and Division of Cardiology, University and Spedali Civili, Brescia, Italy (P.F.).

Correspondence to Francesco Scolari, MD, Divisione di Nefrologia, P. le Ospedale Civile, 1 Spedali Civili, 25125 Brescia, Italy. E-mail fscolar{at}tin.it

Received November 30, 2006; accepted April 13, 2007.

Background— Atheroembolic renal disease (AERD) is caused by showers of cholesterol crystals released by eroded atherosclerotic plaques. Embolization may occur spontaneously or after angiographic/surgical procedures. We sought to determine clinical features and prognostic factors of AERD.

Methods and Results— Incident cases of AERD were enrolled at multiple sites and followed up from diagnosis until dialysis and death. Diagnosis was based on clinical suspicion, confirmed by histology or ophthalmoscopy for all spontaneous forms and for most iatrogenic cases. Cox regression was used to model time to dialysis and death as a function of baseline characteristics, AERD presentation (acute/subacute versus chronic renal function decline), and extrarenal manifestations. Three hundred fifty-four subjects were followed up for an average of 2 years. They tended to be male (83%) and elderly (60% >70 years) and to have cardiovascular diseases (90%) and abnormal renal function at baseline (83%). AERD occurred spontaneously in 23.5% of the cases. During the study, 116 patients required dialysis, and 102 died. Baseline comorbidities, ie, reduced renal function, presence of diabetes, history of heart failure, acute/subacute presentation, and gastrointestinal tract involvement, were significant predictors of event occurrence. The risk of dialysis and death was 50% lower among those receiving statins.

Conclusions— Clinical features of AERD are identifiable. These make diagnosis possible in most cases. Prognosis is influenced by disease type and severity.

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CLINICAL PERSPECTIVE