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August 1987

Eosinophilia as a Clue to the Diagnosis of Atheroembolic Renal Disease

Author Affiliations

Department of Medicine Rush-Presbyterian—St Luke's Medical Center 1753 W Congress Pkwy Chicago, IL 60612

Arch Intern Med. 1987;147(8):1384-1385. doi:10.1001/archinte.1987.00370080020004

Cholesterol embolization to the kidney is a common occurrence, according to the results that have been reported in autopsy studies, in which renal cholesterol emboli were seen in 15% to 30% of patients with severe atherosclerosis of abdominal aorta.1 Cholesterol emboli to the kidney occur with significant frequency following aortic surgery or invasive vascular angiographic studies.1,2 An unknown proportion of these patients show clinical manifestations, predominantly as acute renal failure. Atheroembolism to the kidney is diagnosed correctly ante mortem in only a few of these patients.

The diagnosis of atheroembolic renal disease is difficult to make because of lack of any characteristic findings in the usual tests of renal function or urinalysis. Physical examination is helpful only if livedo reticularis of the lower extremities, digital infarcts, or retinal cholesterol emboli are present, but these features may not be consistently present. The clinical setting in which this disease occurs