HDCN Article Review/Hyperlink

de Takats DLP, Pollock LE, O'Donnell PJ, Snowden S, Bewick M, Scoble JE

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 present.

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 disease. (John T. Daugirdas, M.D., University of Illinois at Chicago)