Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease is a major cause of mortality and morbidity in patients with chronic kidney disease (CKD). The prevalence of hyperlipidaemia or dyslipidaemias is much higher compared to the general population. Total or low-density lipoprotein (LDL) cholesterol is highest in patients with chronic renal impairment. The majority of patients with CKD do not develop renal failure; indeed, most of them die of cardiovascular causes before the development of renal failure. The K/DOQI (Kidney Disease Outcomes Quality Initiative) guidelines on dyslipidaemias in CKD suggest that all patients should therefore be evaluated for dyslipidaemias. They should have a complete fasting lipid profile with total, LDL and high-density lipoprotein cholesterol, and triglycerides measured to identify those at risk and those who require treatment. Generally, the treatment approach parallels that suggested by the National Cholesterol Education Program Adult Treatment Panel III guidelines, in which the main focus of treatment is the level of LDL cholesterol. Patients with CKD should be considered a "very high risk" category and aggressive therapeutic intervention initiated to reduce the risk of cardiovascular events.
 ...
PMID:Hyperlipidaemia in chronic kidney disease. 1572 17

Cholesterol crystal embolization is a potential complication of atherosclerosis. Approximately one-third of the patients who develop this problem have a history of vascular surgery, angiography or angioplasty hours to weeks before onset. The skin and the kidneys are most frequently involved, but any organ can be affected. Livedo reticularis of the lower extremities and acrocyanosis (known as "blue toe syndrome") are the most common cutaneous manifestations. Histological examination is the only way to definitively diagnose cholesterol crystal embolization. Recently, it has been proposed that cholesterol embolization is associated with vasculitis, and some authors have labeled this condition a "vasculitis look-alike." There is still no specific treatment for this problem, even in cases that progress to renal failure. However, a few case reports in the literature have noted successful treatment with corticosteroids and cyclophosphamide in patients with deteriorating renal function. In this article, we describe two cases of severe cholesterol crystal embolization accompanied by renal dysfunction) and blue toe syndrome. Both patients benefited from corticosteroid and cyclophosphamide therapy.
 ...
PMID:Cholesterol crystal embolization mimicking vasculitis: success with corticosteroid and cyclophosphamide therapy in two cases. 1602 35

Atheroembolic disease is recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aorta and it receive an enormous amount of blood flows. We describe the epidemiologic agents of 19 cases that were diagnosed by histologic sections of the affected tissues; the eosinophilia and the renal failure are the clinical features that guide to the diagnosis, in patients with ischemic nephropathy and general atherosclerosis. 53% among patients had a previous invasive procedure and 26% occurred spontaneously. We remark the importance of the kidney's biopsy in diagnosis of the atheroembolic disease and their bad prognosis with 63% of death rate in 18 months of average follow-up. We report patients with the multiple cholesterol emboli syndrome mimicking systemic vasculitis: they died by multivisceral acute failure. The subacute presentation of atheroembolic disease with progressive renal failure treated with hemodialysis is a sign of bad prognosis. The knowledge of the disease and their prevention are the better treatment.
 ...
PMID:[Diagnosis and prognosis of atheroembolic disease]. 1651 4

Cholesterol crystal embolism (CCE) is a multivisceral disease caused by occlusion of small arteries with cholesterol crystal emboli deriving from eroded atherosclerotic plaques of the aorta and/or large feeder arteries. The factors precipitating CCE are manipulation of the aorta or other large arteries during arteriography or surgery, and anticoagulant or thrombolytic therapy. CCE has been reported to be a life threatening condition involving multiple vital organ dysfunction, including renal failure, cardiac failure, skin ischemic lesions such as livedo reticularis, patchy skin necrosis, and purple toes, gastrointestinal ischemia, and/or visual disturbance. We report a 63-year-old male patient of CCE after percutaneous transluminal coronary angioplasty, who contracted severe pneumonia of Pneumocystis carinii and Cytomegalo virus during steroid therapy (prednisolone 20 mg for 3 months). He was treated successfully with mechanical ventilation, hemodialysis, and appropriate antibiotic therapy. Although corticosteroid therapy has been reported to be effective in some CCE patients, the indications of steroid therapy, dosage of corticosteroids, duration of the treatment, or efficacy of prophylactic administration of antibiotics are not yet established. Further interventional studies are required in order to evaluate the benefit of corticosteroid therapy for CCE.
 ...
PMID:[Pulmonary infection of Pneumocystis carinii and Cytomegalo virus in the treatment of cholesterol crystal embolism]. 1691 63

Although cholesterol crystal embolism can present with diffuse visceral involvement, lung lesions do not occur unless there is left to right circulatory shunting. Pulmonary atheroembolism was confirmed by histology in an elderly male with recent end-stage renal failure (ESRF) due to atheroembolic renal disease, who presented with massive hemoptysis and intractable respiratory failure. At autopsy, atheromatous degeneration of the aorta was observed and acute cholesterol emboli found in the kidneys, spleen, liver, stomach and lung. Cholesterol clefts were seen in pulmonary arterioles, and ischemic alveolar damage was present. The pulmonary arteries had no atheromatous changes. Intrapulmonary, intracardiac, and aortocaval shunting were not present. Pulmonary atheroembolism arising from a dialysis fistula has not been previously reported.
 ...
PMID:Pulmonary atheroembolism via an AV shunt. 1701 68

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.
 ...
PMID:[Thoracic aortic dissection revealed by systemic cholesterol embolism]. 1707 70

We report a 72 year-old male, that after a coronary angiogram presented pain, reduced distal skin temperature of both limbs, cyanosis of toes with preserved peripheral pulses and a rapidly progressive renal failure. Afterwards, the patient suffered a sudden bilateral amblyopia and hematochezia. Cholesterol embolism was confirmed with a skin biopsy and fundoscopy. A colonoscopy showed a possible ischemic colitis. After six months of follow up, the patient lost the distal phalanges of three toes, and renal failure stabilized, with a serum creatinine of 2.5 mg/dl. The diagnosis of cholesterol embolism is often missed, but it has a one year mortality of 80% and the presence of renal failure is the main prognostic indicator. Other prognostic indicators are the presence of high blood pressure, previous renal failure and peripheral artery disease.
 ...
PMID:[Cholesterol embolism: report of one case]. 1727 61

Atheroembolic renal disease is a part of a multisystem disease and can be defined as renal failure secondary to the occlusion of renal arterioles and glomerular capillaries with cholesterol crystal emboli deriving from the aorta and other major arteries. The kidney is usually involved because of the proximity of the renal arteries to abdominal aorta (where the erosion of atheromatous plaque is most likely to occur), and the high renal blood flow. Cholesterol crystal embolism can also occur in other visceral organs, as well as in the upper and lower extremities. Embolization may occur spontaneously or after angiographic and surgical procedures, and anticoagulation. Atheroembolic renal disease is an important yet underdiagnosed component of the spectrum of kidney diseases associated with atherosclerosis and remains an unexplored field of nephrology research.
 ...
PMID:[Atheroembolic renal disease: a diagnostic challenge]. 1875 18

OBJECTIVE: Community health centers (HCs) provide care for millions of medically underserved Americans with disproportionate burdens of hypertension and hyperlipidemia. For both conditions, treatment guidelines recently became more stringent and quality improvement (QI) efforts have intensified. We assessed hypertension and hyperlipidemia management in HCs during this time of guideline revision and increased QI efforts. DESIGN: Cross-sectional chart review. SETTING AND PARTICIPANTS: Eleven Midwestern HCs for 2000 and 9 for 2002 provided audit data from 2,976 randomly chosen patients with hypertension and/or hyperlipidemia. MEASUREMENT: Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI/VII) and National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) guidelines were used to assess management of these conditions. RESULTS: Hypertension (2000, N=808; 2002, N=692) and hyperlipidemia (2000, N=774; 2002, N=702) outcomes improved for specific clinical subgroups. Hypertensive patients with 1 or more cardiovascular risk factors demonstrated significant improvement (34% vs. 45% controlled at <140/90 mm Hg, p=0.02). Hypertension control for persons with diabetes, renal failure and heart failure increased (16% vs. 28% controlled at <130/85 mm Hg, p=0.006). LDL control increased significantly for patients with 2 or more risk factors (39% vs. 58% controlled at <130 mg/dl, p=0.008). Other clinical subgroups showed trends toward better control, although there was insufficient power to detect significant differences for these groups. CONCLUSION: Hypertension and hyperlipidemia outcomes improved for some risk groups; however, ongoing QI is necessary.
 ...
PMID:Hypertension and hyperlipidemia management in patients treated at community health centers. 1941 46

Cholesterol crystal embolism with renal impairment is increasingly recognised as an iatrogenic complication of invasive vascular procedures. We present a 58-year-old patient in whom the presence of a classic triad of precipitating event (coronary angiography), subacute presentation of renal failure and cutaneous lesions (livedo reticularis and Blue Toe syndrome) suggested this entity. The confirmatory diagnosis was made by means of renal biopsy which revealed cholesterol crystals lodged in arteries. In our patient severe renal insufficiency requiering hemodialysis ensued. Glucocorticoid and statin therapy failed to recover the renal function. The patient died from acute myocardial infarction. Invasive cardiac procedures are increasing in number especially in the elderly population so higher incidence of cholesterol crystal embolism coud be expected in the future. Increased awareness of this syndrome is necessary for early recognition, which is crucial for treatment, and defining the high-risk patient in whom other modalities of coronary diagnostics coud be considered.
 ...
PMID:[Cholesterol crystal embolism and renal insufficiency: case report and literature review]. 2003 Feb 88


<< Previous 1 2 3 4 5 Next >>