Cholesterol Embolism Atheroembolic Renal Disease

Atheroembolic renal disease is one in which the kidneys fail because the arteries that supply them become blocked. The kidney is then deprived of oxygen-carrying blood.

What is going on in the body?

Blockage in the renal arteries can be caused by these conditions:

an aneurysm, or bulging in the wall of the blood vessel

atherosclerosis, which causes a buildup of a fatty substance called plaque

an embolism, which is a blood or cholesterol clot that travels from some other place in the body

What are the causes and risks of the disease?

The following can cause atherosclerosis:

diabetes

high blood pressure

high cholesterol

infection

smoking

Some of the causes of blood clots are as follows:

arrhythmias, or irregular heartbeats

coronary heart disease

heart valve disease

plaque buildup

The following can cause cholesterol clots:

complications from procedures on the heart, such as cardiac catheterization

medicine used to break up clots

plaque buildup

vascular surgery

Aneurysms can be formed by the following:

high blood pressure over a long period of time

plaque buildup

poorly understood genetic factors

trauma to the blood vessel, such as surgery or a gunshot wound

What are the signs and symptoms of the disease?

Symptoms depend on what causes the blocked artery. They can include the following:

abdominal pain

blood in the urine

high blood pressure

nausea

pain in the back between the ribs and the hips

How is the disease diagnosed?

Diagnosis of atheroembolic renal disease begins with a medical history and physical exam. Screening tests used to confirm the diagnosis may include the following:

blood tests

nuclear medicine kidney scans with or without the use of a medicine called captopril

renal angiography, which is an X-ray test that uses contrast agent to show the inside of the arteries

What can be done to prevent the disease?

Some cases of atheroembolic renal disease cannot be prevented. Other times, the following steps may prevent the disease:

control of blood glucose levels, if the person has diabetes

control of high blood pressure

a heart-healthy diet

regular exercise

monitoring and treating cholesterol as needed

smoking cessation as needed

What are the long-term effects of the disease?

Long-standing high blood pressure can cause heart attacks, strokes, and death. Untreated atheroembolic disease may also cause kidney failure. Blood clots can rupture, causing dramatic blood loss. This may lead to shock, and even death.

What are the risks to others?

Atheroembolic disease is not contagious and poses no risk to others.

What are the treatments for the disease?

Plaque buildup that causes high blood pressure is often treated with medication. If this doesn’t work, other options are as follows:

angioplasty, a procedure in which the narrowed artery is opened through a narrow tube

surgery to reconstruct the artery

surgery to remove the plaque from the artery

surgery to replace the artery with an artificial graft

A renal artery aneurysm is only treated if it is large or if it is causing very high blood pressure. If the aneurysm is in a small branch of the artery, the branch may be removed. This will cause loss of that small portion of the kidney, but it will prevent other problems. Other aneurysms may require surgery.

Blood clots are treated with a thrombolytic medication, such as streptokinase or urokinase. These medicines break down blood clots. If this doesn’t work, surgery may be done to remove the clot or the kidney.

What are the side effects of the treatments?

Thrombolytic medications can cause bleeding. Renal artery angioplasty may result in persistent bleeding or an infection. Kidney damage can occur but is rare. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the disease?

Most people will be able to resume their normal activities shortly after treatment.

How is the disease monitored?

blood pressure, cholesterol, and blood glucose levels will be monitored as needed. Any new or worsening symptoms should be reported to the healthcare provider.