Acute renal failure following an invasive procedure
using radiocontrast material has a limited differential diagnosis.
Congestive heart failure with impaired renal perfusion is unlikely
because the patient showed no other evidence to support a clinical
diagnosis of decompensated cardiac pump function. The transient
bout of hypotension was not severe enough to cause acute renal
failure from ischemic acute tubular necrosis. Contrast nephrotoxicity
is possible in view of the underlying risk factors (ie, diabetes
mellitus, renal failure), the amount of contrast dye utilized, and
the temporal association of renal failure. Yet, the combination of
acute renal failure with severe hypertension, purple toes, and
gastrointestinal bleeding following an invasive vascular procedure
most strongly suggests a diagnosis of cholesterol embolization to
the kidneys, lower extremities, and gastrointestinal tract.
Atherosclerotic debris mobilized from aortic plaques during the
procedure is the source of cholesterol emboli in this circumstance.
- Cholesterol embolization to the small arteries and arterioles
in the kidney.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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Updated 1/04/08 kkj