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Atheroembolic Renal Disease

Alternate Names

  • atherosclerotic renal vascular disease
  • renal artery embolism
  • cholesterol embolism
  • renal artery aneurysm
  • Kidneys and ureters
  • Site of renal arteriography
  • Renal arteriography

Definition

Atheroembolic renal disease is one in which the kidneys fail because the arteries that supply them become blocked. The kidney is then deprived of oxygen-carrying blood.

What is going on in the body?

Blockage in the renal arteries can be caused by these conditions:
  • an aneurysm, or bulging in the wall of the blood vessel
  • atherosclerosis, which consists of a buildup of a fatty substance called plaque in the arteries
  • an embolism, which is a blood or cholesterol clot that travels from some other place in the body and lodges in an artery

Risks

What are the causes and risks of the disease?

The following can cause atherosclerosis:
  • diabetes
  • high blood pressure
  • high cholesterol
  • infection
  • smoking
Some of the causes of blood clots are as follows:
  • arrhythmias, or irregular heartbeats
  • coronary heart disease
  • heart valve disease
  • plaque buildup
The following can cause cholesterol clots:
  • complications from procedures on the heart, such as cardiac catheterization
  • medicine used to break up clots
  • plaque buildup
  • vascular surgery
Aneurysms can be formed by the following:
  • high blood pressure over a long period of time
  • plaque buildup
  • poorly understood genetic factors
  • trauma to the blood vessel, such as surgery or a gunshot wound

Prevention

What can be done to prevent the disease?

Some cases of atheroembolic renal disease cannot be prevented. Other times, the following steps may prevent the disease:
  • control of blood glucose levels, if the person has diabetes
  • control of high blood pressure
  • a heart-healthy diet
  • regular exercise
  • monitoring and treating cholesterol as needed
  • smoking cessation as needed

Diagnosed

How is the disease diagnosed?

Diagnosis of atheroembolic renal disease begins with a medical history and physical exam.
Tests used to confirm the diagnosis may include the following:
  • blood tests
  • nuclear medicine kidney scans with or without the use of a medicine called captopril (i.e., Capoten)
  • renal angiography, which is an X-ray test that uses contrast agent to show the inside of the arteries
  • ultrasound of the kidney
  • a special X-ray test called spiral CT

Long Term Effects

What are the long-term effects of the disease?

Long-standing high blood pressure can cause heart attacks, strokes, and death. Untreated atheroembolic disease may also cause kidney failure. Blood clots can rupture, causing dramatic blood loss. This may lead to shock, and even death.

Other Risks

What are the risks to others?

Atheroembolic disease is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

Anticoagulant (blood-thinning), or in some cases thrombolytic (clot-busting) medication, such as streptokinase or urokinase, is sometimes given in the hope of dissolving the clot.
If this fails to work, other options include:
  • angioplasty, a procedure in which the narrowed artery is opened through a narrow tube
  • surgery to reconstruct the artery
  • surgery to remove the plaque from the artery
  • surgery to replace the artery with an artificial graft
  • surgery to remove the clot or the kidney
A renal artery aneurysm is only treated if it is large or if it is causing very high blood pressure. If the aneurysm is in a small branch of the artery, the branch may be removed. This will cause loss of that small portion of the kidney, but it will prevent other problems.

Side Effects

What are the side effects of the treatments?

Thrombolytic medications can cause bleeding. Renal artery angioplasty may result in persistent bleeding or an infection. Kidney damage can occur but is rare. Surgery may be complicated by bleeding, infection, or reactions to anesthesia.

After Treatment

What happens after treatment for the disease?

Most people will be able to resume their normal activities shortly after treatment.

Monitor

How is the disease monitored?

Blood pressure, cholesterol, and blood glucose levels will be monitored as needed. Any new or worsening symptoms should be reported to the healthcare professional.

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