Cholesterol Emboli

Q: Which of the following has shown to be beneficial in cholesterol embolic disease?

A) Hemodialysis (HD)
B) LDL apheresis
C) Smoking
D) High BMI
E) Keeping higher blood pressure



Answer: B

Cholesterol emboli  is a dreaded devastating complication of atherosclerosis particularly after vascular procedures. Kidney failure can be permanent. Various approaches have been tried including steroids, statin and anticoagulation. Some data suggests that LDL aphresis may be helpful in such situations. Actually, a combination therapy of LDL aphresis, low-dose steroid, and an Angiotensin II receptor blockers (ARBs) has been suggested as an effective treatment.

HD has no role in cholesterol emboli unless kidney failure happens (choice A)

Smoking, high BMI and hypertension are actually risk factors for cholesterol emobli (Choices C, D and E).

#nephrology
#surgicalcriticalcare
#vascular



References:

1. Hasegawa M, Sugiyama S. Apheresis in the treatment of cholesterol embolic disease. Ther Apher Dial 2003; 7:435. 

2. Tamura K, Umemura M, Yano H, et al. Acute renal failure due to cholesterol crystal embolism treated with LDL apheresis followed by corticosteroid and candesartan. Clin Exp Nephrol 2003; 7:67.

3. Muso E, Mune M, Fujii Y, et al. Significantly rapid relief from steroid-resistant nephrotic syndrome by LDL apheresis compared with steroid monotherapy. Nephron 2001; 89:408.