Atheroembolic renal disease
Atheroembolic renal disease
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DOI：
10.1016/s0140-6736(09)62073-0
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发表时间：
2010-05-08
期刊：
影响因子：
168.9
通讯作者：
Ravani, Pietro
中科院分区：
文献类型：
--
作者：
Scolari, Francesco;Ravani, Pietro
当动脉粥样斑块破裂时，动脉粥样硬化性肾脏疾病就会发生，释放胆固醇结晶到小的肾动脉。栓塞术通常影响其他器官，如皮肤、胃肠道系统和大脑。虽然这种疾病可以自发发展，但它通常是在血管手术、插管或抗凝后发展起来的。动脉粥样硬化栓塞症的全身性使诊断变得困难。急性或亚急性肾功能衰竭和皮肤损害这三种典型的突发性事件都强烈地提示了这种疾病。嗜酸性粒细胞增多症进一步支持这一诊断，通常通过病变器官的活检或眼底镜下在视网膜循环中发现胆固醇晶体来证实。肾脏和患者的预后都很差。治疗主要是预防性的，以避免进一步的诱发因素为基础，并有症状，旨在最佳地治疗高血压和心脏和肾功能衰竭。他汀类药物可以稳定动脉粥样硬化斑块，应该提供给所有患者。类固醇可能在伴有全身性炎症的急性或亚急性进展性疾病中起作用。
Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often affects other organs, such as the skin, gastrointestinal system, and brain. Although the disease can develop spontaneously, it usually develops after vascular surgery, catheterisation, or anticoagulation. The systemic nature of atheroembolism makes diagnosis difficult. The classic triad of a precipitating event, acute or subacute renal failure, and skin lesions, are strongly suggestive of the disorder. Eosinophilia further supports the diagnosis, usually confirmed by biopsy of an affected organ or by the fundoscopic finding of cholesterol crystals in the retinal circulation. Renal and patient prognosis are poor. Treatment is mostly preventive, based on avoidance of further precipitating factors, and symptomatic, aimed to the optimum treatment of hypertension and cardiac and renal failure. Statins, which stabilise atherosclerotic plaques, should be offered to all patients. Steroids might have a role in acute or subacute progressive forms with systemic inflammation.