Atheroembolic Kidney Disease
In atheroembolic kidney disease, numerous small pieces of fatty material (atheroemboli) travel from arteries above the kidneys to clog the smallest branches of the renal arteries, causing the kidneys to fail.
Tiny pieces of hard fatty material adhering to a blood vessel wall, usually the aorta, break off and travel to the smallest renal arteries, blocking the blood supply. Usually, this process affects both kidneys equally and at the same time.
The fatty material may break off spontaneously when there is severe atherosclerosis of the aorta. It may also occur as a complication of surgery or angioplasty, or imaging procedures that involve the aorta, such as angiography, when pieces of fatty material adhering to the walls of the aorta are unintentionally broken off. Atheroembolic kidney disease is much more common in older people.
Symptoms and Diagnosis
Atheroembolic kidney disease usually produces slowly progressive failure of the kidneys that causes no symptoms until the failure is advanced. If the blockage of arteries results from a surgical or imaging procedure involving the aorta, the kidneys often fail suddenly. Urine production is often decreased.
As the duration and severity of kidney failure increase, a wide variety of symptoms may appear, beginning with fatigue, nausea, loss of appetite, itching, and difficulty concentrating. The symptoms reflect disturbances in the muscles, brain and nerves, heart, digestive tract, and skin that result from kidney failure.
Atheroemboli may cause symptoms in other organs. If atheroemboli travel to the arms or legs, particularly the toes, such symptoms as a lacy purplish discoloration of the skin and even gangrene may result. Pieces of atheroemboli that travel to an eye may cause sudden blindness.
A kidney biopsy is the best way for a doctor to make the diagnosis; microscopic examination of a tissue sample shows characteristic evidence of fatty material in the smallest arteries. If the skin is discolored, a skin biopsy may be helpful.
Prognosis and Treatment
If the emboli travel to the brain, they may cause small strokes. Prognosis depends on how soon the body reacts to prevent additional pieces of fatty material from breaking off as fatty emboli. If the body reacts quickly, minimal damage may result. If pieces continue to break off, parts of the body may fail and death can follow.
The only treatments for advanced kidney failure are kidney dialysis and, in some cases, transplantation.
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