Puksić Silva, Haris Visnja, Ljubanović Danica, Durasević Zeljko, Galesić Kresimir
Klinika za unutarnje bolesti, Klinicka bolnica Dubrava, Zagreb.
Lijec Vjesn. 2009 Sep-Oct;131(9-10):254-9.
Cholesterol crystal embolism with renal impairment is increasingly recognised as an iatrogenic complication of invasive vascular procedures. We present a 58-year-old patient in whom the presence of a classic triad of precipitating event (coronary angiography), subacute presentation of renal failure and cutaneous lesions (livedo reticularis and Blue Toe syndrome) suggested this entity. The confirmatory diagnosis was made by means of renal biopsy which revealed cholesterol crystals lodged in arteries. In our patient severe renal insufficiency requiering hemodialysis ensued. Glucocorticoid and statin therapy failed to recover the renal function. The patient died from acute myocardial infarction. Invasive cardiac procedures are increasing in number especially in the elderly population so higher incidence of cholesterol crystal embolism coud be expected in the future. Increased awareness of this syndrome is necessary for early recognition, which is crucial for treatment, and defining the high-risk patient in whom other modalities of coronary diagnostics coud be considered.
胆固醇结晶栓塞伴肾功能损害日益被认为是侵入性血管操作的医源性并发症。我们报告一名58岁患者，其具有典型的三联征：诱发事件（冠状动脉造影）、肾衰竭的亚急性表现和皮肤病变（网状青斑和蓝趾综合征），提示了该疾病。通过肾活检确诊，肾活检显示动脉中有胆固醇结晶。在我们的患者中，随后出现了需要血液透析的严重肾功能不全。糖皮质激素和他汀类药物治疗未能恢复肾功能。患者死于急性心肌梗死。侵入性心脏操作的数量正在增加，尤其是在老年人群中，因此预计未来胆固醇结晶栓塞的发病率会更高。提高对该综合征的认识对于早期识别很有必要，这对治疗至关重要，同时有助于确定可考虑采用其他冠状动脉诊断方式的高危患者。
