The challenge of diagnosing atheroembolic renal disease clinical features and prognostic factors
The challenge of diagnosing atheroembolic renal disease clinical features and prognostic factors
复制标题
DOI：
10.1161/circulationaha.106.680991
复制
发表时间：
2007-07-17
期刊：
影响因子：
37.8
通讯作者：
Barrett, Brendan J.
中科院分区：
文献类型：
--
作者：
Scolari, Francesco;Ravani, Pietro;Barrett, Brendan J.
背景：动脉粥样硬化性肾病（AERD）是由动脉粥样硬化斑块侵蚀释放的胆固醇晶体阵雨引起的。栓塞可能自发发生，也可能在血管造影/外科手术后发生。我们试图确定AERD的临床特征和预后因素。方法和结果-在多个地点登记AERD事件病例，并从诊断到透析和死亡进行随访。诊断是基于临床怀疑，所有自发形式和大多数医源性病例的组织学或眼科检查证实。使用Cox回归来模拟透析时间和死亡作为基线特征、AERD表现（急性/亚急性与慢性肾功能下降）和肾外表现的函数。354名受试者平均随访2年。他们往往是男性（83%）和老年人（60% - 70岁），有心血管疾病（90%）和基线时肾功能异常（83%）。23.5%的病例为自发性AERD。在研究期间，116名患者需要透析，102人死亡。基线合并症，如肾功能减退、糖尿病存在、心力衰竭史、急性/亚急性表现和胃肠道受累，是事件发生的重要预测因素。接受他汀类药物治疗的患者发生透析和死亡的风险降低了50%。结论：AERD的临床特征是可识别的。这些使诊断在大多数情况下是可能的。预后受疾病类型和严重程度的影响。
Background - Atheroembolic renal disease (AERD) is caused by showers of cholesterol crystals released by eroded atherosclerotic plaques. Embolization may occur spontaneously or after angiographic/surgical procedures. We sought to determine clinical features and prognostic factors of AERD.Methods and Results - Incident cases of AERD were enrolled at multiple sites and followed up from diagnosis until dialysis and death. Diagnosis was based on clinical suspicion, confirmed by histology or ophthalmoscopy for all spontaneous forms and for most iatrogenic cases. Cox regression was used to model time to dialysis and death as a function of baseline characteristics, AERD presentation (acute/subacute versus chronic renal function decline), and extrarenal manifestations. Three hundred fifty-four subjects were followed up for an average of 2 years. They tended to be male (83%) and elderly (60% > 70 years) and to have cardiovascular diseases (90%) and abnormal renal function at baseline ( 83%). AERD occurred spontaneously in 23.5% of the cases. During the study, 116 patients required dialysis, and 102 died. Baseline comorbidities, ie, reduced renal function, presence of diabetes, history of heart failure, acute/subacute presentation, and gastrointestinal tract involvement, were significant predictors of event occurrence. The risk of dialysis and death was 50% lower among those receiving statins.Conclusions - Clinical features of AERD are identifiable. These make diagnosis possible in most cases. Prognosis is influenced by disease type and severity.