Abstract: TH-PO0050
A Stable Aneurysm, an Unstable Kidney: A Case of Biopsy-Proven Atheroembolic Disease
Session Information
- AKI: Pathogenesis and Disease Mechanisms
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ohonba, Nosagie, Overlook Medical Center, Summit, New Jersey, United States
- Patel, Dhwanil G., Overlook Medical Center, Summit, New Jersey, United States
- Sekulic, Miroslav, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States
- Seepaulsingh, Paige, Overlook Medical Center, Summit, New Jersey, United States
- Mousa, Marlin, Overlook Medical Center, Summit, New Jersey, United States
Introduction
Atheroembolic renal disease (AERD) is a systemic manifestation of cholesterol crystal embolism, often underdiagnosed due to its insidious onset and nonspecific presentation. It typically occurs after vascular procedures or anticoagulation and is associated with high morbidity. We present a case of biopsy-confirmed AERD following endovascular abdominal aortic aneurysm (AAA) repair.
Case Description
A 69-year-old man with hypertension, coronary artery disease and AAA with a penetrating ulcer underwent successful endovascular repair. His creatinine rose from a baseline of 1.0 mg/dL to 1.8 mg/dL at discharge. 4 months later, he presented with worsening renal function (creatinine 4.82 mg/dL). Renal artery duplex and aortic imaging ruled out stenosis or endoleak. A renal biopsy at that time, revealed cholesterol crystal emboli involving small arteries and glomeruli, along with severe arteriolosclerosis. These findings were suggestive of AERD. He was managed with antihypertensives and supportive care. Over the following months, his renal function stabilized, and he avoided dialysis.
Discussion
AERD is caused by cholesterol crystal embolization from ulcerated atherosclerotic plaques into small renal arteries. Common iatrogenic triggers include vascular surgery, catheterization, thrombolysis, and anticoagulation. Incidence post-aortic surgery is estimated at 1-4%, but autopsy studies suggest subclinical rates may be higher. The kidneys are involved in up to 50% of systemic cases. Risk factors include age, male sex, hypertension, and atherosclerosis.
This case underscores the delayed, progressive nature of AERD. Notably, the patient had a brief creatinine rise post-surgery that stabilized, followed by a late surge months later—typical of the disease's biphasic pattern. Definitive diagnosis requires biopsy, showing cholesterol clefts in arteries and arterioles. Prognosis is poor, with over 40% developing end-stage kidney disease and mortality nearing 60% at one year.
Management is supportive: blood pressure control, anticoagulation cessation, statins, and avoidance of further vascular insult. Steroids have not shown consistent benefit. This case highlights the need to recognize AERD in patients with progressive renal failure post-vascular interventions, especially when imaging is unrevealing and urinalysis lacks active sediment.