Vidt D G, Eisele G, Gephardt G N, Tubbs R, Novick A C
Cleve Clin J Med. 1989 Jun;56(4):407-13. doi: 10.3949/ccjm.56.4.407.
In elderly patients with generalized atherosclerosis and longstanding hypertension, progressive renal insufficiency should suggest renal artery occlusive disease and/or renal cholesterol embolization. Renal cholesterol embolization is not an absolute contraindication to successful surgical revascularization. Renal cholesterol emboli were identified in biopsy specimens obtained in 24 cases at the Cleveland Clinic from 1978 to 1986, and renal artery stenosis was an associated finding in 19. Clinical manifestations of generalized atherosclerosis were common, including ileofemoral atherosclerosis (18), coronary artery disease (16), carotid occlusive disease (15), and carotid occlusive disease with a history of stroke (8). Evidence of embolic events in other organs was common. Hypertension worsened before biopsy in 21 patients with and without renal artery stenosis. Surgery or angiography definitely or probably contributed to renal failure in 16. Of 12 who underwent surgical revascularization of a renal artery, renal function improved in five, remained stable in five, and worsened in one. Renal function improved in the three patients undergoing dialysis before revascularization, and two were able to discontinue dialysis.
在患有全身性动脉粥样硬化和长期高血压的老年患者中，进行性肾功能不全应提示肾动脉闭塞性疾病和/或肾胆固醇栓塞。肾胆固醇栓塞并非成功进行外科血管重建的绝对禁忌证。1978年至1986年期间在克利夫兰诊所获取的活检标本中，在24例中发现了肾胆固醇栓子，其中19例伴有肾动脉狭窄。全身性动脉粥样硬化的临床表现很常见，包括髂股动脉粥样硬化（18例）、冠状动脉疾病（16例）、颈动脉闭塞性疾病（15例）以及有中风病史的颈动脉闭塞性疾病（8例）。其他器官出现栓塞事件的证据也很常见。在有或无肾动脉狭窄的21例患者中，活检前高血压病情加重。手术或血管造影肯定或可能导致了16例患者出现肾衰竭。在接受肾动脉外科血管重建的12例患者中，5例肾功能改善，5例保持稳定，1例恶化。在血管重建前接受透析的3例患者中，肾功能得到改善，2例能够停止透析。
