Acute renal failure due to cholesterol crystal embolism treated with LDL apheresis followed by corticosteroid and candesartan.

Abstract	Cholesterol crystal embolism (CCE) is caused by the shedding of cholesterol crystals into the bloodstream, and it has been recently recognized as a serious complication after vascular procedures. Our case of CCE, which was diagnosed by skin and renal biopsies, occurred in a patient with hypertension and diabetes mellitus, 3 months after coronary angiography, with the development of renal failure and blue toes. After low-density lipoprotein apheresis (LDL-A), the skin lesions, including livedo reticularis and pain from the acrocyanotic toes, dramatically improved, with partial recovery of renal function. Following the administration of low-dose corticosteroid and candesartan--an angiotensin II type 1 receptor antagonist (ARB)--the eosinophilia disappeared and renal function improved gradually with a decrease in urinary protein excretion. Therefore, a combination therapy of LDL-A, low-dose corticosteroid, and an ARB is a possible treatment for CCE, although the possibility of spontaneous recovery of renal function cannot be eliminated for this patient.
Authors	Kouichi Tamura, Masanari Umemura, Hideto Yano, Masashi Sakai, Yoko Sakurai, Yuko Tsurumi, Yuichi Koide, Takashi Usui, Machiko Yabana, Yoshiyuki Toya, Yasuo Tokita, Satoshi Umemura
Journal	Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 7 Issue 1 Pg. 67-71 (Mar 2003) ISSN: 1342-1751 [Print] Japan
PMID	14586747 (Publication Type: Case Reports, Journal Article)
Chemical References	Adrenal Cortex Hormones Angiotensin II Type 1 Receptor Blockers Benzimidazoles Biphenyl Compounds Lipoproteins, LDL Tetrazoles C-Reactive Protein Prednisolone Creatinine candesartan
Topics	Acute Kidney Injury (diagnosis, etiology, therapy) Adrenal Cortex Hormones (therapeutic use) Aged Angiotensin II Type 1 Receptor Blockers Benzimidazoles (therapeutic use) Biopsy Biphenyl Compounds Blood Component Removal C-Reactive Protein (analysis) Coronary Angiography Creatinine (blood) Crystallization Embolism, Cholesterol (complications, diagnosis) Eosinophils Humans Kidney (pathology) Leukocyte Count Lipoproteins, LDL (blood) Male Prednisolone (therapeutic use) Proteinuria Renal Dialysis Skin (pathology) Tetrazoles (therapeutic use)

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