How are cholesterol emboli associated with end-stage renal disease (ESRD)?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Cholesterol emboli may affect any organ; however, the skin and kidneys are affected most commonly. The subacute nature of this disorder frequently results in an inaccurate diagnosis; however, skin biopsy may readily reveal the diagnosis. [14] Emboli can develop spontaneously or follow an invasive vascular procedure such as an arteriogram. Embolization may occur either shortly after the procedure or many weeks later. Renal failure resulting from cholesterol emboli may evolve slowly or transpire precipitously. The cutaneous signs of cholesterol emboli include livedo reticularis, petechiae, purpura, and blue toes. Because aortic atherosclerotic plaques are the primary source of emboli, the lower extremities are affected most commonly.

Patients frequently develop constitutional symptoms (eg, fever, myalgias) that may complicate the clinical picture further. Laboratory studies, although not diagnostic, are fairly characteristic, demonstrating not only a leukocytosis and elevated erythrocyte sedimentation rate (ESR) but also an eosinophilia. Specific organ involvement may be reflected in laboratory abnormalities. Serum amylase, creatine kinase, or hepatic transaminases may be elevated in association with pancreatic, muscle, or hepatic involvement, respectively.

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