De La Prada Alvarez F J, Blanco Huelga C, Prados Gallardo A M, Uriol Rivera M
Servicio de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
An Med Interna. 2004 May;21(5):231-4.
The cholesterol embolism syndrome is a multisystemic disease resulting from cholesterol crystal emboli deriving from ulcerous atherosclerotic plaques of the aorta or large arteries. Cholesterol crystal embolization can affect multiple organ, including the skin, kidney, brain, eyes, gastrointestinal tract and extremities, and mimic other systemic diseases like vasculitis. Cholesterol crystal embolization of lungs has been described and should be included in the differential diagnostic of pulmonary-renal syndromes. The diagnosis of cholesterol embolism should be considered in elderly patients with pre-existing atherosclerotic disease who develop renal failure and clinical features of peripheral cholesterol crystal embolization in association with precipitating event, without the need for histological demonstration of cholesterol clefts. This syndrome is associated with high morbidity and mortality but recent reports suggest that an aggressive therapeutic management with patient-tailored supportive measures, avoids precipitating factors, and the use of corticosteroids may be associated with a favorable clinical outcome.
胆固醇栓塞综合征是一种多系统疾病,由源自主动脉或大动脉溃疡性动脉粥样硬化斑块的胆固醇晶体栓子引起。胆固醇晶体栓塞可累及多个器官,包括皮肤、肾脏、大脑、眼睛、胃肠道和四肢,并可类似血管炎等其他全身性疾病。肺部胆固醇晶体栓塞已有报道,应纳入肺肾综合征的鉴别诊断。对于患有动脉粥样硬化疾病的老年患者,在出现肾衰竭以及与促发事件相关的外周胆固醇晶体栓塞临床特征时,应考虑胆固醇栓塞的诊断,而无需胆固醇裂隙的组织学证明。该综合征与高发病率和死亡率相关,但最近的报告表明,积极的治疗管理、针对患者的支持措施、避免促发因素以及使用皮质类固醇可能会带来良好的临床结果。