胆固醇结晶栓塞肾损伤临床及病理表现

Clinicopathological manifestations of the renal damage due to cholesterol crystal embolism

目的探讨胆固醇结晶栓塞的临床特点、肾脏病理表现、治疗和预后。方法回顾性分析胆固醇结晶栓塞患者的临床及肾活检病理资料。结果11例胆固醇结晶栓塞患者中10例存在动脉粥样硬化,7例行血管介入治疗,2例新加用华法林,余2例为自发性。6例患者出现蓝趾综合征,9例伴血嗜酸细胞比例升高。所有患者均有蛋白尿,10例伴急性/亚急性肾功能不全。8例患者行肾活检病理检查见弓状动脉管腔内针形裂隙,肾间质中-重度淋巴单核细胞及部分嗜酸细胞浸润。10例随访患者中,1例肾功能维持正常,9例肾功能不全者除1例死亡外,余患者无改善,其中4例维持血液透析治疗。结论胆固醇结晶栓塞临床表现各异,建议有明确动脉粥样硬化病史,介入和/或抗凝后出现无法解释的急性/亚急性肾功能不全时,均应积极行肾活检病理检查。

Objectives Kidney is frequently involved in cholesterol crystal embolism,but this renal injury is easily to be disregarded and misdiagnosed.Objective To investigate the clinicopathological features,treatment and outcome of the renal injury due to cholesterol crystal embolism.Methods The clinicopathological data of the patients with renal injury due to cholesterol crystal embolism were retrospectively reviewed.Results In this cohort,10 of the 11 patients had atherosclerosis.The renal injury was induced by interventional therapy in 7 patients and by newly administered warfarin in 2 patients,and occurred spontaneously in 2 patients.Blue toe syndrome was found in 6 patients,and eosinophilia was present in 9 patients.All the patients had proteinuria,and 10 patients had renal insufficiency.Eight patients received renal biopsy.Pathological findings consisted of artery thickening and stenosis with needle-shaped clefts in the occluded vessels,and moderate to severe infiltration of lymphomonocytes and some eosinophils.Ten patients were followed up;renal function was normal in one patient and was insufficient in 9 patients,in which one died,and 8 patients showed no improvement in renal function.At the end of follow-up,4 patients were dialysis-dependent.Conclusion The clinical manifestation of cholesterol crystal embolism varied.Renal biopsy and pathological examination are required in unexplained acute or subacute renal insufficiency patients complicated with atherosclerosis,interventional therapy,and/or anticoagulant treatment.