Cristiana Rollino

BACKGROUND: Atheroembolic renal disease (AERD) is caused by showers of cholesterol crystals released by eroded atherosclerotic plaques. Embolization may occur spontaneously or after angiographic/surgical procedures. We sought to determine clinical features and prognostic factors of AERD. METHODS AND RESULTS: Incident cases of AERD were enrolled at multiple sites and followed up from diagnosis until dialysis and death. Diagnosis was based on clinical suspicion, confirmed by histology or ophthalmoscopy for all spontaneous forms and for most iatrogenic cases. Cox regression was used to model time to dialysis and death as a function of baseline characteristics, AERD presentation (acute/subacute versus chronic renal function decline), and extrarenal manifestations. Three hundred fifty-four subjects were followed up for an average of 2 years. They tended to be male (83%) and elderly (60% >70 years) and to have cardiovascular diseases (90%) and abnormal renal function at baseline (83%). AERD occurred spontaneously in 23.5% of the cases. During the study, 116 patients required dialysis, and 102 died. Baseline comorbidities, ie, reduced renal function, presence of diabetes, history of heart failure, acute/subacute presentation, and gastrointestinal tract involvement, were significant predictors of event occurrence. The risk of dialysis and death was 50% lower among those receiving statins. CONCLUSIONS: Clinical features of AERD are identifiable. These make diagnosis possible in most cases. Prognosis is influenced by disease type and severity.

A new conglutinin solid phase assay for the detection of immune complexes containing IgA (IgAIC) and other conglutinin tests for immune complexes containing IgG and IgM (IgGIC and IgMIC) were used in studies on 34 patients affected by Berger's GN (92 sera) and 12 affected by Henoch-Schoenlein GN (61 sera). Thirty-six patients were observed over follow-up periods of 2-43 months. Levels of IgAIC in both groups of patients were significantly higher than those in healthy people. The values obtained in patients with Henoch-Schoenlein GN were statistically higher than those obtained in patients with Berger's GN. Moreover, IgAIC were frequently found to be associated with IgGIC and/or IgMIC. In both groups of patients, the IgAIC levels were significantly correlated with the presence of signs of clinical and histological activity such as the magnitude of microscopic hematuria, a past history of macroscopic hematuria and the percentage of glomeruli with florid epithelial crescents.