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Kidney Week

Abstract: TH-PO051

Long-Term Outcome of Biopsy-Proven Cholesterol Crystal Embolism

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Toriu, Naoya, Toranomon Hospital, Tokyo, Japan
  • Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mizuno, Hiroki, Toranomon Hospital, Tokyo, Japan
  • Yamanouchi, Masayuki, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
  • Hoshino, Junichi, Toranomon Hospital, Tokyo, Japan
  • Ubara, Yoshifumi, Toranomon Hospital, Tokyo, Japan

Cholesterol crystal embolism (CCE) causes renal damage, and there is an extremely high risk of end-stage renal disease. However, the time course of CCE-related renal deterioration varies and little is known about the subsequent risk of dialysis among patients with biopsy-proven CCE.


We performed a retrospective cohort study of 38 Japanese patients in whom a histological diagnosis of CCE was made from September 1992 to July 2005. Competing risk regression analysis was used to investigate the association between declining renal function (≥ 1.5-fold elevation of serum creatinine within 26 weeks after CCE) or its subtypes (acute [<1 week after CCE], subacute [1 to <6 weeks], and chronic [6 to <26 weeks]) and the risk of dialysis, with adjustment for age, baseline serum creatinine, and the precipitating event.


During a median follow-up period of 25.9 weeks, 14 patients (35.9%) started dialysis. Multivariable analysis showed that patients with declining renal function had a higher risk of commencing dialysis than those without declining function (subdistribution hazard ratio [SHR]: 9.47; 95% confidence interval [CI]: 1.34-66.8). Patients with different renal presentations had a similarly increased risk of commencing dialysis, with the risk being significantly higher for the subacute and chronic patterns of declining renal function (adjusted SHR [95% CI] for acute, subacute, and chronic declining renal function[vs. no decline]: 7.36 [0.85-63.6], 11.9 [1.36-101], and 10.7 [1.49-77.0], respectively).


Declining renal function after CCE, even later than 6 weeks, was significantly associated with the subsequent risk of dialysis.