Cholesterol emboli syndrome laboratory findings: Difference between revisions

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==Overview==
==Overview==
== Laboratory Findings ==  
== Laboratory Findings ==  
===Blood and urine===
Tests for [[inflammation]] ([[C-reactive protein]] and the [[erythrocyte sedimentation rate]]) are typically elevated, and abnormal [[liver enzyme]]s may be seen.<ref name=Modi/> If the kidneys are involved, tests of [[renal function]] (such as [[urea]] and [[creatinine]]) are elevated. The [[complete blood count]] may show particularly high numbers of a type of [[white blood cell]] known as ''[[eosinophil]]s'' (more than 0.5 billion per liter); this occurs in only 60-80% of cases, so normal eosinophil counts do not rule out the diagnosis.<ref name=Fukumoto/> Examination of the urine may show [[red blood cell]]s (occasionally in [[urinary casts|casts]] as seen under the microscope) and increased levels of protein; in a third of the cases with kidney involvement, eosinophils can also be detected in the urine. If vasculitis is suspected, [[complement]] levels may be determined as reduced levels are often encountered in vasculitis; complement is a group of proteins that forms part of the innate [[immune system]]. Complement levels are frequently reduced in cholesterol embolism, limiting the use of this test in the distinction between vasculitis and cholesterol embolism.<ref>{{cite journal |author=Cosio FG, Zager RA, Sharma HM |title=Atheroembolic renal disease causes hypocomplementaemia |journal=Lancet |volume=2 |issue=8447 |pages=118–21 |year=1985 |month=July |pmid=2862317 |doi=10.1016/S0140-6736(85)90225-9}}</ref>


* Organ specific damage
*Laboratory findings consistent with the diagnosis of [[Cholesterol emboli syndrome]] include<ref name="Ozkok2019">{{cite journal|last1=Ozkok|first1=Abdullah|title=<p>Cholesterol-embolization syndrome: current perspectives</p>|journal=Vascular Health and Risk Management|volume=Volume 15|year=2019|pages=209–220|issn=1178-2048|doi=10.2147/VHRM.S175150}}</ref><ref name="FukumotoTsutsui2003">{{cite journal|last1=Fukumoto|first1=Yoshihiro|last2=Tsutsui|first2=Hiroyuki|last3=Tsuchihashi|first3=Miyuki|last4=Masumoto|first4=Akihiro|last5=Takeshita|first5=Akira|title=The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study|journal=Journal of the American College of Cardiology|volume=42|issue=2|year=2003|pages=211–216|issn=07351097|doi=10.1016/S0735-1097(03)00579-5}}</ref>
*:* Renal failure - rapidly progressive in many cases <cite>greenberg</cite>
**Tests for [[inflammation]] ([[C-reactive protein]] and the [[erythrocyte sedimentation rate]]) are typically elevated
*:* Myocardial infarction - serum creatine kinase (CPK) and troponin elevation
**abnormal [[liver enzyme]]s
*:* Mesenteric ischemia - Bloody (OB+) stool common
**If the kidneys are involved, tests of [[renal function]] (such as [[urea]] and [[creatinine]]) are elevated.
*:* Stroke
**The [[complete blood count]] may show particularly high numbers of a type of [[white blood cell]] known as ''[[eosinophil]]s'' (more than 0.5 billion per liter); this occurs in only 60-80% of cases, so normal [[eosinophil]] counts do not rule out the diagnosis.<ref name="CecioniFassio2007">{{cite journal|last1=Cecioni|first1=Ilaria|last2=Fassio|first2=Filippo|last3=Gori|first3=Stefano|last4=Giudizi|first4=Maria Grazia|last5=Romagnani|first5=Sergio|last6=Almerigogna|first6=Fabio|title=Eosinophilia in cholesterol atheroembolic disease|journal=Journal of Allergy and Clinical Immunology|volume=120|issue=6|year=2007|pages=1470–1471|issn=00916749|doi=10.1016/j.jaci.2007.07.014}}</ref>
* Full septic picture may ensue
**Examination of the urine may show [[red blood cell]]s (occasionally in [[urinary casts|casts]] as seen under the microscope) and increased levels of [[protein]]; in a third of the cases with [[kidney]] involvement, [[eosinophils]] can also be detected in the [[urine]].
*:* Adult Respiratory Distress Syndrome (ARDS) <cite>greenberg</cite>  
**If [[vasculitis]] is suspected, [[complement]] levels may be determined as reduced levels are often encountered in [[vasculitis]][[; complement]] is a group of [[proteins]] that forms part of the innate [[immune system]]. [[Complement]] levels are frequently reduced in [[cholesterol embolism syndrome]], limiting the use of this test in the distinction between [[vasculitis]] and [[cholesterol embolism syndrome]].<ref>{{cite journal |author=Cosio FG, Zager RA, Sharma HM |title=Atheroembolic renal disease causes hypocomplementaemia |journal=Lancet |volume=2 |issue=8447 |pages=118–21 |year=1985 |month=July |pmid=2862317 |doi=10.1016/S0140-6736(85)90225-9}}</ref>
*:* Microangiopathic hemolysis (disseminated intravascular coagulopathy)  
*:* Hypotension is usually a late finding


=== Electrolyte and Biomarker Studies ===
* If Organ damage occurs, laboratory findings include
*:* [[Renal failure]] - increased serum [[creatinine]] and BUN <cite>greenberg</cite>
*:* [[Myocardial infarction]] - serum [[creatine kinase]] (CPK) and [[troponin]] elevation
*:* [[Mesenteric ischemia]] - Bloody (OB+) stool common


* Peripheral eosinophilia <cite>moolenaarneth</cite>  
=== Biomarker Studies ===
* Urinary eosinophilia - usually in patients with cholesterol-renal disease  
*increased ESR and CRP
* May have leukocytosis (even >20K/µL) with left shift  
* Peripheral [[eosinophilia]] <cite>moolenaarneth</cite>  
* Hypocomplementemia is common
* [[eosinophiluria]] - usually in patients with cholesterol-renal disease  
* Sed rates are nonspecifically elevated
* [[Hematuria]]
* Thrombocytopenia due to aggregation and complement activation
* [[proteinuria]]
* May have [[leukocytosis]] (even >20K/µL) with left shift  
* [[Hypocomplementemia]] is common
* [[Thrombocytopenia]] due to aggregation and complement activation


==References==
==References==

Latest revision as of 22:15, 19 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory Findings

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References

  1. Ozkok, Abdullah (2019). "

    Cholesterol-embolization syndrome: current perspectives

    ". Vascular Health and Risk Management. Volume 15: 209–220. doi:10.2147/VHRM.S175150. ISSN 1178-2048.
  2. Fukumoto, Yoshihiro; Tsutsui, Hiroyuki; Tsuchihashi, Miyuki; Masumoto, Akihiro; Takeshita, Akira (2003). "The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study". Journal of the American College of Cardiology. 42 (2): 211–216. doi:10.1016/S0735-1097(03)00579-5. ISSN 0735-1097.
  3. Cecioni, Ilaria; Fassio, Filippo; Gori, Stefano; Giudizi, Maria Grazia; Romagnani, Sergio; Almerigogna, Fabio (2007). "Eosinophilia in cholesterol atheroembolic disease". Journal of Allergy and Clinical Immunology. 120 (6): 1470–1471. doi:10.1016/j.jaci.2007.07.014. ISSN 0091-6749.
  4. Cosio FG, Zager RA, Sharma HM (1985). "Atheroembolic renal disease causes hypocomplementaemia". Lancet. 2 (8447): 118–21. doi:10.1016/S0140-6736(85)90225-9. PMID 2862317. Unknown parameter |month= ignored (help)


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