RSS Feeds
Patient Care after Percutaneous Coronary Artery Interventions
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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].
Chike Magnus Nzerue, MD
Morehouse School of Medicine; Atlanta, GA 30310
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
