Atheromatous Emboli with Progressive Renal Failure

Abstract

Two patients studied by renal arteriography as part of an evaluation for hypertension subsequently developed progressive deterioration of renal function and within 2 to 4 months died in uremia. Atheroembolic disease of the kidney, severe enough to account for the renal failure, was demonstrated by renal biopsy or autopsy. Both patients had severe erosive atheromatous disease of the abdominal aorta and underlying nephrosclerosis with moderate renal insufficiency. The conclusion that the renal arteriography was the critical factor in the initiation of progressive renal failure is based on the temporal relationship between arteriography and the deterioration of renal function, the actual demonstration of embolization during the arteriographic procedure in one of the patients, and the findings of extensive atheroembolism of the kidneys in both. Renal arteriography is an invaluable diagnostic tool, but unless the indications are urgent, it should probably be avoided in patients with extensive arteriosclerosis and impaired renal function. If it is deemed necessary, however, manipulation with rigid catheters should be held to a minimum.