Cholesterol embolism

Cholesterol embolism occurring after vascular surgery or intra-arterial angiographic procedures is not uncommon, but is often unrecognized. The clinical features mimic several conditions, including contrast nephropathy and systemic vasculitis, and—if misdiagnosed—can result in the inappropriate use of powerful immunosuppressive drugs. A high index of suspicion is required when an elderly patient with widespread vascular disease develops a non-specific systemic illness with progressive renal impairment, particularly after vascular surgery or arteriography. Biopsy of affected tissue, especially skin or kidney, is diagnostic—showing biconvex, needle-shaped cholesterol clefts within the lumen of arteries or arterioles. Treatment is supportive and the prognosis is often poor.

Renal emergencies

This chapter discusses renal emergencies, including acute kidney injury (AKI), anuria, interstitial nephritis, rhabdomyolysis, hepatorenal syndrome, acute upper urinary tract infections, renal colic and renal stones, haematuria, renovascular disease, cholesterol embolism, and contrast nephropathy.