Cholesterol emboli syndrome medical therapy: Difference between revisions

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{{Cholesterol emboli syndrome}}
{{Cholesterol emboli syndrome}}
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==Overview==
==Overview==
Some pharmacologic medical therapies that can be effective for [[cholesterol emboli syndrome]] include [[statins]], [[corticosteroids]], [[colchicine]], [[cyclophosphamide]] and [[IL1]] antagonists.
==Medical Therapy==
==Medical Therapy==
Treatment of an episode of cholesterol emboli is generally symptomatic, i.e. it deals with the symptoms and complications but cannot reverse the phenomenon itself. In kidney failure resulting from cholesterol crystal emboli, [[statin]]s have been shown to halve the risk of requiring [[hemodialysis]].
*There is no definitive treatment for  [[cholesterol emboli syndrome]]; the mainstay of therapy is supportive care.
* No definitive therapy at this time; supportive care, fluids
*Pharmacologic medical therapies that can be effective for [[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>
* The role of anticoagulation is not clear – some of advocated anticoagulation and others have warned against it.
**[[Statins]]
* Some have advocated lipid-lowering agents.
*** [[Statins]] can stabilize the [[atherosclerotic]] plaques. <ref name="Akdimvan Leuven2007">{{cite journal|last1=Akdim|first1=Fatima|last2=van Leuven|first2=Sander|last3=P. Kastelein|first3=John|last4=G. Stroes|first4=Erik|title=Pleiotropic Effects of Statins: Stabilization of the Vulnerable Atherosclerotic Plaque?|journal=Current Pharmaceutical Design|volume=13|issue=10|year=2007|pages=1003–1012|issn=13816128|doi=10.2174/138161207780487548}}</ref>
* Unclear role for glucocorticoids, even when significant eosinophilia is present
***[[Statins]] reduce [[inflammation]]. <ref name="TousoulisPsarros2014">{{cite journal|last1=Tousoulis|first1=Dimitris|last2=Psarros|first2=Costas|last3=Demosthenous|first3=Michael|last4=Patel|first4=Rikhil|last5=Antoniades|first5=Charalambos|last6=Stefanadis|first6=Christodoulos|title=Innate and Adaptive Inflammation as a Therapeutic Target in Vascular Disease|journal=Journal of the American College of Cardiology|volume=63|issue=23|year=2014|pages=2491–2502|issn=07351097|doi=10.1016/j.jacc.2014.01.054}}</ref>
*:* Anecdotal case reports have reported improvement
***[[Statins]] reduce the risk of developing [[ESRD]] and [[dialysis]] requirement. <ref name="WoolfsonLachmann1998">{{cite journal|last1=Woolfson|first1=Robin G|last2=Lachmann|first2=Helen|title=Improvement in renal cholesterol emboli syndrome after simvastatin|journal=The Lancet|volume=351|issue=9112|year=1998|pages=1331–1332|issn=01406736|doi=10.1016/S0140-6736(05)79058-9}}</ref>
**[[Corticosteroid]]s <ref name="urlCholesterol crystal embolization (CCE): Improvement of renal function with high-dose corticosteroid treatment Desai M, Ram R, Prayaga A, Dakshinamurty K V - Saudi J Kidney Dis Transpl">{{cite web |url=https://www.sjkdt.org/text.asp?2011/22/2/327/77621 |title=Cholesterol crystal embolization (CCE): Improvement of renal function with high-dose corticosteroid treatment Desai M, Ram R, Prayaga A, Dakshinamurty K V - Saudi J Kidney Dis Transpl |format= |work= |accessdate=}}</ref> <ref name="pmid12165941">{{cite journal |vauthors=Stabellini N, Cerretani D, Russo G, Rizzioli E, Gilli P |title=[Renal atheroembolic disease: evaluation of the efficacy of corticosteroid therapy] |language=Italian |journal=G Ital Nefrol |volume=19 |issue=1 |pages=18–21 |date=2002 |pmid=12165941 |doi= |url=}}</ref> <ref name="YücelKart-Köseoglu2005">{{cite journal|last1=Yücel|first1=A. E.|last2=Kart-Köseoglu|first2=H.|last3=Demirhan|first3=B.|last4=Özdemir|first4=F. N.|title=Cholesterol crystal embolization mimicking vasculitis: success with corticosteroid and cyclophosphamide therapy in two cases|journal=Rheumatology International|volume=26|issue=5|year=2005|pages=454–460|issn=0172-8172|doi=10.1007/s00296-005-0012-4}}</ref>
***high dose of [[corticosteroid]]s has been shown effective but not in the long term.
**[[Colchicine]] <ref>{{cite journal|doi=10.1016/j.atherosclerosis.2017.12.02}}</ref> <ref name="RobertsonMartínez2016">{{cite journal|last1=Robertson|first1=Stacy|last2=Martínez|first2=Gonzalo J.|last3=Payet|first3=Cloe A.|last4=Barraclough|first4=Jennifer Y.|last5=Celermajer|first5=David S.|last6=Bursill|first6=Christina|last7=Patel|first7=Sanjay|title=Colchicine therapy in acute coronary syndrome patients acts on caspase-1 to suppress NLRP3 inflammasome monocyte activation|journal=Clinical Science|volume=130|issue=14|year=2016|pages=1237–1246|issn=0143-5221|doi=10.1042/CS20160090}}</ref>
**[[Cyclophosphamide]]
** [[IL1]] antagonists might be effective due to their anti-inflammatory effects.


==References==
==References==

Latest revision as of 21:47, 20 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nasrin Nikravangolsefid, MD-MPH [2]

Overview

Some pharmacologic medical therapies that can be effective for cholesterol emboli syndrome include statins, corticosteroids, colchicine, cyclophosphamide and IL1 antagonists.

Medical Therapy

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. Akdim, Fatima; van Leuven, Sander; P. Kastelein, John; G. Stroes, Erik (2007). "Pleiotropic Effects of Statins: Stabilization of the Vulnerable Atherosclerotic Plaque?". Current Pharmaceutical Design. 13 (10): 1003–1012. doi:10.2174/138161207780487548. ISSN 1381-6128.
  3. Tousoulis, Dimitris; Psarros, Costas; Demosthenous, Michael; Patel, Rikhil; Antoniades, Charalambos; Stefanadis, Christodoulos (2014). "Innate and Adaptive Inflammation as a Therapeutic Target in Vascular Disease". Journal of the American College of Cardiology. 63 (23): 2491–2502. doi:10.1016/j.jacc.2014.01.054. ISSN 0735-1097.
  4. Woolfson, Robin G; Lachmann, Helen (1998). "Improvement in renal cholesterol emboli syndrome after simvastatin". The Lancet. 351 (9112): 1331–1332. doi:10.1016/S0140-6736(05)79058-9. ISSN 0140-6736.
  5. "Cholesterol crystal embolization (CCE): Improvement of renal function with high-dose corticosteroid treatment Desai M, Ram R, Prayaga A, Dakshinamurty K V - Saudi J Kidney Dis Transpl".
  6. Stabellini N, Cerretani D, Russo G, Rizzioli E, Gilli P (2002). "[Renal atheroembolic disease: evaluation of the efficacy of corticosteroid therapy]". G Ital Nefrol (in Italian). 19 (1): 18–21. PMID 12165941.
  7. Yücel, A. E.; Kart-Köseoglu, H.; Demirhan, B.; Özdemir, F. N. (2005). "Cholesterol crystal embolization mimicking vasculitis: success with corticosteroid and cyclophosphamide therapy in two cases". Rheumatology International. 26 (5): 454–460. doi:10.1007/s00296-005-0012-4. ISSN 0172-8172.
  8. . doi:10.1016/j.atherosclerosis.2017.12.02. Missing or empty |title= (help)
  9. Robertson, Stacy; Martínez, Gonzalo J.; Payet, Cloe A.; Barraclough, Jennifer Y.; Celermajer, David S.; Bursill, Christina; Patel, Sanjay (2016). "Colchicine therapy in acute coronary syndrome patients acts on caspase-1 to suppress NLRP3 inflammasome monocyte activation". Clinical Science. 130 (14): 1237–1246. doi:10.1042/CS20160090. ISSN 0143-5221.


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