Gross proteinuria and subacute renal failure after coronary angiography - a case report of cholesterol crystal embolization

Abstract

We report on a 55-year-old man who was admitted with increased serum-creatinine (3.4 mg/dl), gross proteinuria (4.6 g/24 h) and arterial hypertension. The medical history included hyperlipidemia, coronary artery disease (CAD) and a recent coronary angiography, but normal serum-creatinine and no proteinuria before coronary intervention. Serology and urinary analysis did not show any signs of a systemic disease. A renal biopsy, however, revealed multiple cholesterol crystal emboli in small vessels along with a typical infiltration of eosinophilic granulocytes. The patient was subsequently treated with an angiotensin-receptor-1 (AT1R) blocker and high-dose statins and was then evaluated for LDL-apheresis. Gross proteinuria was largely unaffected by (AT1R) blockade and renal function further declined necessitating, initiation of hemodialysis. Renal CCE with profound proteinuria is an unusual presentation of acute renal failure, potentially misleading and thereby prolonging correct diagnostics of a rare entity. Identification of high-risk patients is of utmost importance as efficient therapeutic strategies do not exist.