Li Xuezhu, Bayliss George, Zhuang Shougang
Division of Nephrology, Tongji University School of Medicine, Shanghai 200120, China.
Department of Medicine, Rhode Island Hospital and Alpert Medical School, Brown University, Providence, RI 02903, USA.
Int J Mol Sci. 2017 May 24;18(6):1120. doi: 10.3390/ijms18061120.
Renal disease caused by cholesterol crystal embolism (CCE) occurs when cholesterol crystals become lodged in small renal arteries after small pieces of atheromatous plaques break off from the aorta or renal arteries and shower the downstream vascular bed. CCE is a multisystemic disease but kidneys are particularly vulnerable to atheroembolic disease, which can cause an acute, subacute, or chronic decline in renal function. This life-threatening disease may be underdiagnosed and overlooked as a cause of chronic kidney disease (CKD) among patients with advanced atherosclerosis. CCE can result from vascular surgery, angiography, or administration of anticoagulants. Atheroembolic renal disease has various clinical features that resemble those found in other kidney disorders and systemic diseases. It is commonly misdiagnosed in clinic, but confirmed by characteristic renal biopsy findings. Therapeutic options are limited, and prognosis is considered to be poor. Expanding knowledge of atheroembolic renal disease due to CCE opens perspectives for recognition, diagnosis, and treatment of this cause of progressive renal insufficiency.
当小块动脉粥样硬化斑块从主动脉或肾动脉脱落并散落至下游血管床后，胆固醇结晶栓塞在小肾动脉中时，就会引发由胆固醇结晶栓塞（CCE）导致的肾脏疾病。CCE是一种多系统疾病，但肾脏特别容易受到动脉粥样硬化栓塞疾病的影响，这种疾病可导致肾功能急性、亚急性或慢性下降。这种危及生命的疾病在晚期动脉粥样硬化患者中可能未得到充分诊断，并被忽视作为慢性肾脏病（CKD）的一个病因。CCE可由血管手术、血管造影或抗凝剂的使用引起。动脉粥样硬化栓塞性肾病具有多种临床特征，类似于其他肾脏疾病和全身性疾病中发现的特征。它在临床上常被误诊，但通过特征性的肾活检结果得以确诊。治疗选择有限，且预后被认为较差。对由CCE引起的动脉粥样硬化栓塞性肾病的认识不断扩展，为识别、诊断和治疗这种进行性肾功能不全的病因开辟了前景。
