RESUMO
Background: We report a unique case of renal cholesterol crystal embolism (CCE) induced by carotid artery stenting that was successfully treated with evolocumab, a fully human monoclonal antibody against proprotein convertase subtilisin kexin type 9 (PCSK9).Case presentation: A 77-year-old man with hypertension, hyperlipidemia, and chronic kidney disease was referred to our department for decreased estimated glomerular filtration rate (eGFR)-from 32.0 to 13.9 mL/min/1.73 m2-5 weeks after carotid artery stenting. Further examination revealed livedo reticularis in the bilateral toes and eosinophilia (723/µL). Skin biopsy from livedo reticularis tissue in the bilateral toes showed cholesterol clefts in the small arteries. The patient was therefore diagnosed with CCE. After 25 weeks' administration of evolocumab at a dose of 140 mg subcutaneously administered every 2 weeks, his eGFR had improved from 10.7 to 18.1 mL/min/1.73 m2.Conclusion: Evolocumab may have a beneficial effect on renal involvement in patients with CCE.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Estenose das Carótidas/diagnóstico , Embolia de Colesterol/tratamento farmacológico , Inibidores de PCSK9 , Stents/efeitos adversos , Idoso , Estenose das Carótidas/cirurgia , LDL-Colesterol/sangue , Embolia de Colesterol/etiologia , Humanos , Masculino , Pele/patologia , Resultado do TratamentoAssuntos
Cateteres de Demora/efeitos adversos , Doenças do Íleo/etiologia , Fístula Intestinal/etiologia , Perfuração Intestinal/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Remoção de Dispositivo , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/instrumentação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 55-year-old man with Marfan syndrome taking warfarin for anticoagulant therapy after aortic valve replacement developed acute kidney injury (serum creatinine level of 9.01 mg/dL) and gross macrohematuria. Renal biopsy showed red cell casts in the renal tubules, glomerular crescent formation in the glomeruli with immunoglobulin A deposition, and global sclerosis. Based on these findings, the patient was diagnosed with warfarin-related nephropathy with acute kidney injury characterized by immunoglobulin A nephropathy with crescents. The warfarin was withdrawn, and his hematuria and renal function improved without immunosuppressive agents.