Atheroembolic renal disease

Alternative names:

atheroemboli - renal; atherosclerotic disease - renal; cholesterol embolization syndrome; renal disease - atheroembolic

Definition:

A disease of the kidneys involving narrowing of the kidney blood vessels and/or blood clots that form in the renal artery as a complication of atherosclerosis (see also renal artery stenosis).

Causes, incidence, and risk factors:

Atheroembolic renal disease involves damage and destruction of kidney tissue as a result of the blood vessel changes of atherosclerosis. Cholesterol and other lipids deposit along the walls of the blood vessels. This causes the walls of the blood vessel to become less elastic ("hardening of the arteries"). The lipid deposits create uneven blood flow around the deposit and may result in formation of blood clots that may cause acute renal artery occlusion or that may travel to other locations throughout the body (embolize). Atherosclerosis of the aorta can lead to showers of small emboli containing cholesterol and debris. These emboli cause death of many small areas of the kidney and thus permanent acute renal failure or chronic renal failure.

The incidence of atheroembolic renal disease is 4 out of 10,000 people. It is more common in men, especially those over 60 years old. Risk factors for atherosclerotic disorders include having a personal or family history of cerebrovascular disease, heart disease, coronary artery disease, peripheral vascular disease, diabetes mellitus, and hypertension. Smoking, obesity, and high serum lipids (such as total cholesterol and triglycerides) also greatly increase the risk of atherosclerotic disorders.

Clots or emboli may form in the kidney because of atherosclerotic deposits (plaques), or they may travel to the kidney from other locations. Risks for emboli that travel to the kidney increase with a history of thromboembolism (blood clots) in any location, especially if severe enough to require treatment with anticoagulants. Anticoagulant therapy may trigger an attack of atheroembolism. Risks of emboli are also increased with recent aortic surgery or procedures involving the blood vessels such as aortography or arteriography.

Atheroembolic renal disease may cause reduced kidney function including acute or chronic renal failure. It may cause hypertension that is refractory or difficult to control. The disorder may show no symptoms in some cases, unless acute arterial occlusion or renal failure develops. Hypertension that is difficult to control may be the first clue that atheroembolic renal disease exists, or routine examination or examination for other disorders may reveal the disease.