ACUTE KIDNEY INJURY (AKI)-CONTRAST RELATED AKI

SUMMARY

1. Immediate contrast-induced ATN (improves and has no skin findings) vs cholesterol atheroemboli (livedo reticularis, eosinophilia, obvious systemic emboli, kidney injury)

2. Consider cholesterol atheroembolic kidney disease if the AKI develops several days after the procedure.

3. Look for blue toes, livedo reticularis, stepwise progression, eosinophilia, eosinophiluria, and low complements.

4. If diagnosis is in doubt, a skin biopsy of 1 of the systemic lesions can show a cholesterol embolus.

5. Treatment of AKI due to cholesterol emboli is supportive only. Do not anticoagulate.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].