Atheroembolic Renal Disease: Clinico-Pathologic Correlations

It has been known for long time that the course of atherosclerotic disease may be complicated by systemic manifestations of cholesterol embolism (1). The kidney is frequently involved in this phenomenon (2) which may give rise to diverse clinical pictures. The clinical diagnosis of atheroembolic renal disease may be easy in the presence of other embolic manifestations (livedo reticularis, digital ischemic necrosis, retinal emboli) and a clinical history of angiography, angioplasty and recent abdominal aortic surgery. In these cases, the cutaneous and muscular biopsies may provide valid and not invasive diagnostic support (3). When atheroembolism appears spontaneously, in the absence of causal events, and the clinical history is of acute or chronic renal failure of unknown origin, only renal biopsy with pathognomonic findings of needle-shaped cholesterol crystals within the vessel lumen permits diagnosis, distinguishing atheroembolic lesions from those of nephroangiosclerosis or other pathologies.