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Cholesterol atheroembolic kidney disease — ABIM Board MCQ

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HardNephrologyCholesterol atheroembolic kidney diseaseABIM Board

Ten days after coronary angiography, a 74-year-old man develops worsening kidney function. Examination shows livedo reticularis and painful blue toes with palpable pedal pulses. Eosinophils are 11%, complement is low and urinalysis has only trace protein. Which diagnosis best explains the kidney injury?

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Correct answer: B — Cholesterol crystal embolization after arterial instrumentation

The best answer is “Cholesterol crystal embolization after arterial instrumentation”. The delayed onset after arterial instrumentation, intact distal pulses, cutaneous embolic findings, eosinophilia, low complement and relatively bland urine sediment form the classic pattern of cholesterol crystal embolization. Contrast-associated injury usually begins within the first few days and does not cause systemic embolic skin findings.

Reference: Cholesterol Crystal Embolism Induced Kidney Disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC12272466/