Recovery of renal function after renal failure due to cholesterol crystal embolism.

was negative. Funduscopy showed splinter haemorrhages cholesterol crystal embolism without Hollenhorst plaques. Doppler sonographic study of carotid and femoral arteries was normal. Scintigraphy study Sir, with 99Tcm-MAG3 revealed poor perfusion and loss of Cholesterol crystal embolism (CCE) is not a widely recog-excretory function in both kidneys. nized cause of kidney failure [1]. Previous reports have A livedoid skin lesion was biopsied revealing the presence emphasized the progressive nature of renal insufficiency from of cholesterol crystal emboli that occluded the lumen of the this cause [2], and reports of improvement of renal function dermis media arterioles. Renal function deteriorated later after CCE are rare [2–4]. We present a case of CCE with and serum creatinine increased to a peak of 574.2 mmol/l on secondary kidney failure, livedoid lesions and lower limb day 82 after the coronariography. Later, a slow and progress-intermittent claudication, in which complete recovery of renal ive recovery of the renal function was detected with a urea function occurred after several months. level of 18.3 mmol/l and serum creatinine level of 203 mmol/l at 6 months. A further improvement was detected and at the Case. A 53-year-old male, with a long-standing history of 24 month-follow-up, the urea level was 11.3 mmol/l and the hypertension and ischaemic cardiopathy was admitted for serum creatinine was 123 mmol/l. Proteinuria was negative cardiological evaluation. He was a non-smoker, and was and the urine sediment was normal. Intermittent claudication chronically treated with 50 mg/day atenolol, 40 mg/day iso-of the lower limbs improved after the third month. Treatment sorbide mononitrate and 200 mg/day aspirin. On admission, during this time period included 10 mg/day amlodipine, serum creatinine level was 106 mmol/l, proteinuria was absent 50 mg/day atenolol and 4 mg/day doxazosine. The renal and the urine sediment was normal. No other relevant data function has remained stable after 24 months of follow-up were found. Coronary angiography via the femoral artery (Figure 1). was performed, and a critical stenosis of the left anterior descending coronary artery was detected. One month later, he complained of headache, intermittent claudication of the Comment. Although partial improvement of renal function has been described after CCE [2–4,5], almost complete lower limbs at 50–100 m and diffuse abdominal tenderness that did not respond to antiacids and analgesics. Blood recovery of renal function has only been reported in five cases in the literature [3,4] (MEDLINE, 1980–1998), but pressure was 200/120 mmHg and livedoid lesions …