LETTER
Patient Care after Percutaneous Coronary Artery Interventions
Chike Magnus Nzerue, MD
1 April 1998 | Volume 128 Issue 7 | Page 599
TO THE EDITOR:
Although O'Meara and Dehmer's discussion of contrast-induced nephropathy was illuminating [1], the authors did not mention another renal complication of these interventions-cholesterol atheroembolic renal disease. This is concerning because the disease is the major consideration in the differential diagnosis of contrast nephropathy and diagnosis of atheroembolic renal disease relies on a high index of suspicion.
Cholesterol atheroembolic renal disease results when cholesterol crystals separate from atheromatous plaques; lodge in small renal arteries; and cause ischemia, renal failure, and perivascular inflammation. Embolization results from mechanical disruption of atheromatous plaque during angiographic procedure or, rarely, results spontaneously [2]. It is also helpful to note the differences between contrast nephropathy and atheroembolic renal disease. The former presents with renal failure soon after exposure to contrast (24 to 48 hours) and reaches a nadir in 3 to 4 days. Complete renal recovery occurs within a few days. The onset of atheroembolic renal disease may be delayed for several days or weeks after the inciting event, progression of renal failure is often slow, and recovery of renal function is less likely [3]. Finally, atheroembolic renal disease may present with other features, such as flank pain, hematuria, eosinophilia, livedo reticularis, changes in the lower extremities, and retinal plaque [4].
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Author and Article Information
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Morehouse School of Medicine; Atlanta, GA 30310
1. O'Meara JJ, Dehmer GJ. Care of the patient and management of complications after percutaneous coronary artery interventions. Ann Intern Med. 1997; 127:458-71.
2. Colt HG, Begg RJ, Saporito JJ, Cooper WM, Shapiro AP. Cholesterol emboli after cardiac catheterization. Eight cases and review of the literature. Medicine (Baltimore). 1988; 67:389-400.
3. Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization. A review of 221 cases in the English literature. Angiology. 1987; 38:769-84.
4. Tunick PA, Perez JL, Kronzon I. Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med. 1991; 115:423-7.
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