de Takats DLP, Pollock LE, O'Donnell PJ, Snowden S, Bewick M,
Is cholesterol embolic disease an unrecognized cause of
renal graft dysfunction?
Nephrol Dial Transplant
(Jul) 11:1325-1327 1996
Cholesterol embolic disease is a well known cause of deterioration of
renal function with native kidneys. de Takats and colleagues describe
four cases where cholesterol embolization was found to be the cause of
sudden deterioration of renal function in allografts. All cases were
proven by biopy. Two of the four showed initial non-function, and in
two other patients, cholesterol embolization was delayed. In one it
may have been an incidental finding, as evidence of rejection was also
de Takats also review the other published cases.
In those with initial non-function, the graft had a poor prognosis.
It is not clear if embolization occurred from the donor or from the
recipient. In most cases, atheromatous disease was not apparent in
the recipient at time of surgery. With regards to late cases, the
clinical message appears to be: think of cholesterol emboli if a
transplant patient develops a sudden decrease in renal function after
an interventional study for associated cardiac or peripheral vascular
(John T. Daugirdas, M.D., University of Illinois at Chicago)