Original Paper

Cholesterol Crystal Embolism Syndrome in Dialysis Patients: An Emerging Clinical Diagnosis?
Giorgina Barbara Piccoli, Roberta Fenoglio, Loredana Colla, Donatella Bilucaglia, Elisabetta Mezza, Manuel Burdese, Francesca Bermond, Giuseppe Paolo Segoloni

Nephrology, Internal Medicine Department, University of Turin, Turin, Italy

Address of Corresponding Author

Blood Purif 2006;24:433-438 (DOI: 10.1159/000095359)

  Key Words

• Cholesterol crystal embolism syndrome
• Hemodialysis
• Dialysis, daily
• Peritoneal dialysis
• Corticosteroid therapy
• Prostaglandin analogues

  Abstract

Background: Cholesterol crystal embolism syndrome (CCE) is an increasing end-stage renal disease cause. Few cases have been described on dialysis, despite the high prevalence of the predisposing factors. Methods: The diagnostic criteria of the present study were: skin lesions, myalgia, fatigue, fever and acute inflammatory serologic signs, in the presence of severe vasculopathy. The precipitating factors were: anticoagulation, endovascular intervention and ulcerated atherosclerotic plaque. Results: Between October 2003 and September 2005, CCE was diagnosed in 6 dialysis patients (of 200-210 on chronic treatment): 5 males, 1 female, median age 59.5 years (47-70) and end-stage renal disease follow-up 11.5 years (3-25). All had severe vasculopathy, 5 cardiopathy, and 4 were failed graft recipients. The treatment included: peritoneal dialysis, daily dialysis, 'conventional' hemodialysis (2 cases) and hemodiafiltration. The diagnosis was based on the clinical-laboratory picture in 1 patient. In the 5 others clues were present (dicumarol therapy, angioplasty, femoral artery thrombosis, CCE predialysis and ulcerated aortic plaque). The therapeutic approach consisted of corticosteroids (5 cases), statins (4 cases) and prostaglandin analogues (4 cases). Conclusion: The differential diagnosis of CCE should also be considered in dialysis patients (necrotic lesions, limb pain and vasculitis-like signs).

Copyright © 2006 S. Karger AG, Basel

  Author Contacts

Giorgina Barbara Piccoli, MD
Chair of Nephrology, Internal Medicine Department, University of Turin
Corso Bramante 86-88, IT-10126 Turin (Italy)
Tel. +39 011 67 8887/+39 011 633 5594, Fax +39 011 696 3158
E-Mail gbpiccoli@yahoo.it, giorgina.piccoli@unito.it

  Article Information

Received: October 5, 2005
Accepted: January 31, 2006
Published online: August 25, 2006
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 1, Number of References : 25