Sudden death in patient with cholesterol atheroembolism
Muerte súbita en paciente con ateroembolismo de colesterol
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Heras, M.J. Fernández-Reyes, R. Sánchez, S. Salinas Moreno" "autores" => array:4 [ 0 => array:4 [ "Iniciales" => "M." "apellidos" => "Heras" "email" => array:1 [ 0 => "manuhebe@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "M.J." "apellidos" => "Fernández-Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "R." "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "S." 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In addition to affecting the kidney, cholesterol crystals may also affect small-diameter arteries in other areas, such as the central nervous system, the coronary arteries, the mesentery, and the pancreas, damage to which is one of the principal causes of mortality in these patients.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">A male patient aged 78 years had a personal history of chronic kidney disease that was probably secondary to arterial hypertension and diabetes mellitus (baseline serum creatinine 1.5mg/dl), was a former smoker and had hypercholesterolaemia. In February 2007 he was diagnosed with ischaemic cardiopathy with a severely diseased vessel, and an angioplasty was performed and a stent implanted.Amonth after this procedure, the patient came to the Emergency Room due to frank haematuria related with an excess of oral anticoagulants. The patient was admitted due to finding high levels of serum creatinine at 4.5mg/dl. A physical examination was performed and an arrhythmia was detected by cardiac auscultation, and cyanosis was detected in the first, third and fifth toes on the right foot. The systematic urine analysis showed blood +++ and the 24-hour protein count was 1.2g/day. Other analytical alterations that we detected were as follows: haemoglobin 10.6g/dl, eosinophilia 7.6%, and a decrease in complement C3, 69mg/dl (NV: 79-152) and complement C4, 11mg/dl (NV:16-32). In the kidney ultrasound, the kidneys appeared with cortical cysts, but with no other morphological changes and no sign of enlargement. The echocardiogram showed a decreased EF (29%). Due to lack of improvement of renal function, it was necessary to begin haemodialysis as replacement therapy. During the seventh haemodialysis session, 15 minutes after having begun, the patient went into cardiac arrest and could not be revived.</p><p class="elsevierStylePara">Given that sudden death had arisen from an unclear cause, a necropsy was carried out (thoracic-abdominal study), which revealed a severe aortic atheromatosis and a digestive haemorrhage in the ileum as the most relevant macroscopic findings. The microscopic study revealed the presence of cholesterol crystals in small-diameter arteries in the kidneys, stomach, spleen, pancreas and prostate.</p><p class="elsevierStylePara">Although CE may occur spontaneously in patients with atheromatosis who suffer a breakage in the plaque,<span class="elsevierStyleSup">2</span> in most cases it is derived from inadequate treatment in invasive procedures (angioplasty or vascular surgery) and, over the long term, from anti-coagulation treatment.<span class="elsevierStyleSup">3</span> Depending on the location of the plaque, migration of cholesterol crystals to multiple organs has been described; these include the central nervous system, the retina, coronary arteries, the pancreas and the adrenal glands. In the case of the kidney, such damage can manifest itself as acute (during the first week following the procedure), sub-acute (weeks or months later), or it can be chronic.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">In our case, although there was a high probability that the acute renal failure (ARF) was due to a CE, the autopsy was what confirmed that the kidneys were affected by cholesterol crystals, and that crystals were also present in other organs. There is no cure for CE, so the treatment options are based on symptomatic and preventative measures;<span class="elsevierStyleSup">1,4</span> its mortality rate is high.<span class="elsevierStyleSup">5</span> As with other forms of ARF, the mortality of the patients with CE is not due to ARF (in our case, the patient had begun replacement therapy and was on dialysis when he went into cardiac arrest). Rather, it results from the concomitant visceral ischaemia.<span class="elsevierStyleSup">1</span> In this case, the ultimate cause of the patient’s death may have been the haemorrhage in the ileum shown in the macroscopic study, which we cannot confirm as the pathological examination of the brain has not been carried out.</p>" "pdfFichero" => "P-E-S-A191-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Meyrier A. Cholesterol crystal embolism: diagnosis and treatment. Kidney Int 2006;69:1308-12. 2. Cross SS. How common is cholesterol embolism? J Clin Pathol 1991;44:859-61. 3. Thadhani R, Camargo C, Xavier R, et al. Atheroembolic renal failure after invasive procedures. Natural history based on 52 biopsy-proven cases. Medicine 1995;74:350-8. 4. 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J Am Acad Dermatol 2006;55:786-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17052483" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004752/v0_201502091629/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000003/v0_201502091629/X2013251409004752/v0_201502091629/en/P-E-S-A191-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004752?idApp=UINPBA000064" ]
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| 2019 January | 27 | 11 | 38 |
| 2018 December | 50 | 23 | 73 |
| 2018 November | 76 | 9 | 85 |
| 2018 October | 73 | 9 | 82 |
| 2018 September | 52 | 10 | 62 |
| 2018 August | 52 | 17 | 69 |
| 2018 July | 33 | 9 | 42 |
| 2018 June | 48 | 8 | 56 |
| 2018 May | 45 | 16 | 61 |
| 2018 April | 38 | 3 | 41 |
| 2018 March | 46 | 9 | 55 |
| 2018 February | 45 | 6 | 51 |
| 2018 January | 42 | 8 | 50 |
| 2017 December | 30 | 4 | 34 |
| 2017 November | 20 | 5 | 25 |
| 2017 October | 26 | 4 | 30 |
| 2017 September | 32 | 8 | 40 |
| 2017 August | 21 | 7 | 28 |
| 2017 July | 26 | 5 | 31 |
| 2017 June | 23 | 4 | 27 |
| 2017 May | 32 | 5 | 37 |
| 2017 April | 19 | 3 | 22 |
| 2017 March | 24 | 5 | 29 |
| 2017 February | 25 | 4 | 29 |
| 2017 January | 22 | 4 | 26 |
| 2016 December | 44 | 4 | 48 |
| 2016 November | 48 | 5 | 53 |
| 2016 October | 67 | 7 | 74 |
| 2016 September | 83 | 1 | 84 |
| 2016 August | 130 | 2 | 132 |
| 2016 July | 127 | 8 | 135 |
| 2016 June | 90 | 0 | 90 |
| 2016 May | 96 | 0 | 96 |
| 2016 April | 55 | 0 | 55 |
| 2016 March | 60 | 0 | 60 |
| 2016 February | 78 | 0 | 78 |
| 2016 January | 76 | 0 | 76 |
| 2015 December | 85 | 0 | 85 |
| 2015 November | 64 | 0 | 64 |
| 2015 October | 57 | 0 | 57 |
| 2015 September | 45 | 0 | 45 |
| 2015 August | 56 | 0 | 56 |
| 2015 July | 43 | 0 | 43 |
| 2015 June | 41 | 0 | 41 |
| 2015 May | 44 | 0 | 44 |
| 2015 April | 5 | 0 | 5 |
Show all
