Skin Biopsy as Alternative for Renal Biopsy in Acute Renal Failure and Suspected Cholesterol Emboli Syndrome

A 74-year old man with complaints of malaise was diagnosed with acute renal failure of unknown cause and was referred to our outpatient clinic because of bluish-red maculae in a reticular pattern on his forefeet and toes of unclear duration. Six weeks prior to the onset of his general symptoms he had undergone an endovascular aorta repair (EVAR) procedure. A lesional skin biopsy was taken and revealed multiple cholesterol emboli. The cholesterol emboli syndrome is a complication of atherosclerosis caused by cholesterol crystal embolization. These cholesterol crystals originate from atherosclerotic plaques of the large arteries and can migrate to various organs like the kidneys and the skin where they occlude small arteries causing ischemia and tissue damage. Often precipitating factors like vascular procedures, cardiac or aorta surgery, or treatment with anticoagulant or thrombolytic drugs can be identified. With our cutaneous findings an invasive renal biopsy could be avoided.