ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO383

Nephrotic Range of Proteinuria with Cholesterol Crystal Embolization

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Ataka, Eri, Kokura memorial Hospital, Kitakyushu, Japan
  • Harada, Kenji, Kokura memorial hospital, Kitakyusyu city, Fukuoka, Japan
  • Tsuchimoto, Akihiro, Kyushu University, Fukuoka, Japan
  • Kanai, Hidetoshi, Kokura Memorial Hospital, Kita Kyushu, Japan
Introduction

Cholesterol crystal embolism(CCE) is often caused by transcatheter therapy, vascular surgery or anticoagulant therapy, clinically characterized by vessel obstruction from cholesterol crystals and the subsequently provoked immune response. Once it developed in kidney, renal function may gradually decline. Moreover, renal prognosis is poor with the majority of patients having progressive kidney failure. Generally, proteinuria is rare with CCE patients.

Case Description

Here, we report a case of nephrotic range of proteinuria caused by CCE. A 72-years-old man with atherosclerotic disease such as hypertension, diabetes mellitus and an abdominal aortic aneurysm, underwent percutaneous coronary intervention(PCI) on February 1, 2017. Acute kidney injury and nephrotic range of proteinuria occurred after four months of PCI. Kidney biopsy was performed to determine the etiology of renal dysfunction and massive proteinuria. Renal pathological diagnosis revealed CCE and focal segmental glomerulosclerosis(FSGS), severe endocapillary proliferation with foam cells. Steroid pulse therapy and oral prednisolone at a dose of 30 mg/day were administered. After those therapy serum-creatinine level and protein to creatinine ratio improved from 2.5 mg/dL to 1.3 mg/dL and 8 g/gCr to 0.5 g/gCr, respectively.

Discussion

Renal cholesterol crystal embolization with massive proteinuria is rare. In this case, endocapillary proliferation with foam cells thought to be caused by CCE. These suggests that steroid therapy might be effective treatment for CCE with FSGS lesions accompanied by proteinuria.