Health Encyclopedia

Atheroembolic renal disease

Definition

Atheroembolic renal disease (AERD) is an inflammatory reaction in the small blood vessels of the kidneys.

Alternative Names

Renal disease - atheroembolic; Cholesterol embolization syndrome; Atheroemboli - renal; Atherosclerotic disease - renal

Causes, incidence, and risk factors

AERD is linked to atherosclerosis. Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard substances called plaque.

In AERD, cholesterol crystals from plaque break off and move to the kidneys and into the blood stream. Once in circulation, the crystals get stuck in tiny blood vessels called arterioles. There, they cause an intense inflammatory response. The result is organ damage due to decreased blood supply. Acute kidney failure is possible if the reaction is severe.

Atherosclerosis of the aorta is the most common cause of AERD. The cholesterol crystals may also break off during cardiac catheterization or aortic surgery.

In some cases, AERD may occur without a cause.

The risk factors for AERD are the same as risk factors for atherosclerosis.

Symptoms

AERD may not cause any symptoms. Symptoms that may occur include:

Foot pain, ulcers on the feet, or “blue toes”
Pain in the abdomen, nausea, or vomiting
Pancreatitis or hepatitis (rare)
Strokes or blindness
Flank pain and blood in the urine (rare)
Uncontrolled high blood pressure

Kidney failure may result in the following:

Nausea or vomiting
Loss of appetite
Weight loss
Decreased or no urine output
Swelling
Decrease in sensation
Skin pigment changes
Dry itchy skin
Drowsiness, confusion, lethargy

Signs and tests

The doctor will perform a physical exam. Swelling may affect the entire body. An eye exam may show particles in the small arteries of the retina.

The doctor will listen to your lungs and heart with a stethoscope. Abnormal sounds may be heard. For example, a loud whooshing sound called a bruit may be heard over the aorta or renal artery.

Blood pressure may be high. There may be multiple ulcers of the skin of the lower feet.

Tests that may be done include:

Abdominal CT scan
Abdominal MRI
Abdominal x-ray
Chem-7 or chem-20
Complete blood count
Kidney biopsy
Kidney function tests including BUN and creatinine
Kidney or abdominal ultrasound
Renal arteriography
Serum complement
Serum lipids
Urinalysis

Treatment

Medicines may be used to treat high blood pressure and lower lipid and cholesterol levels.

Other treatments for kidney failure or complications may be needed.

Your doctor may tell you to reduce fats and cholesterol in your diet. If you have kidney failure, you may need to restrict protein, salt, and fluids, or make other dietary changes.

Your doctor may also recommend other lifestyle changes such as increased exercise or weight loss. Stopping smoking is extremely important.

Expectations (prognosis)

The outcome varies but is generally poor. The disorder slowly gets worse over time. Lifestyle changes may help slow progression of the disease.

Complications

Acute renal failure
Chronic renal failure
High blood pressure
Blood clots to other location of the body -- brain, intestine, legs

Calling your health care provider

Call your doctor if you have:

A decrease in urine output or no urine production
Blood in the urine
Severe abdominal pain or leg pain
Unexplained ulcers on your legs or feet
Toes that turn purple and occur with foot pain

Prevention

You can alter the factors that increase your risk of getting this disease. You should lose weight if you are obese, decrease or stop smoking, and follow your doctor's recommendations to control diabetes or high blood pressure. Reducing fats, especially saturated fats, in your diet may help to reduce serum lipid levels.

Review Date:5/15/2007
Reviewed By:Robert Mushnick, M.D., Clinical Assistant Professor, Department of Nephrology, SUNY Downstate Health Center, Brooklyn, NY. Review provided by VeriMed Healthcare Network.

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