Atheroembolic renal disease

Alternative names:

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

Symptoms:

• flank pain or abdominal pain
  • abrupt onset
  • continuous, not "colicky" or spasmodic

• blood in the urine
• pain in the abdomen, legs, or thighs
• foot pain
• purple toes
• multiple spontaneous skin ulcers
• blood pressure, high

Note: There may be no symptoms.

Symptoms of renal failure may develop:

• nausea, vomiting
• loss of appetite
• weight loss
• decreased urine output (or none)
• swelling of the body--any location
• decrease in sensation
• skin pigment changes
  • increase in pigmentation (hyperpigmentation)

• dry skin, itching
• decreased alertness
  • drowsiness, confusion, lethargy

Signs and tests:

An examination may show generalized edema. Fundoscopic examination of the eyes may show particles in the small arteries of the retina. Signs of fluid overload may develop if renal failure is present, including abnormal sounds on examination with a stethoscope (auscultation) of the heart and lungs. A loud whooshing sound (bruit) may be heard on auscultation over the aorta or renal artery. The blood pressure may be elevated, and there may be a history of hypertension that is difficult to control. There may be multiple superficial ulcers of the skin of the lower feet.

These tests help diagnose the disorder:

• blood, protein, eosinophils, or other abnormality in a urinalysis
• CBC abnormal (eosinophilia, thrombocytopenia).
• low serum complement
• high lipids - serum
• Accumulation of nitrogen wastes in the blood (azotemia) if kidney failure develops:
  • BUN elevated.
  • creatinine elevated.

• increased potassium or other abnormality in serum chemistry (chem-7 or chem-20)
• A kidney or abdominal ultrasound, abdominal CT scan, abdominal MRI, or abdominal X-ray may be abnormal, indicating atheroembolic disease.
• A renal arteriography may show acute blockage (occlusion).
• An IVP may show decreased functioning of the kidney.
• A kidney biopsy or biopsy of other suspect tissue may show changes indicating atheroembolic disease.