Abstract: 【Abstract】Objectives Kidney is frequently involved in cholesterol crystal embolism, but this renal injury is easily to be disregarded and misdiagnosed. Objective To investigate the clinicopathological features, treatment and outcome of the renal injury due to cholesterol crystal embolism. Methods The clinicopathological data of the patients with renal injury due to cholesterol crystal embolism were retrospectively reviewed. Results In this cohort, 10 of the 11 patients had atherosclerosis. The renal injury was induced by interventional therapy in 7 patients and by newly administered warfarin in 2 patients, and occurred spontaneously
in 2 patients. Blue toe syndrome was found in 6 patients, and eosinophilia was present in 9 patients. All the patients had proteinuria, and 10 patients had renal insufficiency. Eight patients received renal biopsy. Pathological findings consisted of artery thickening and stenosis with needle-shaped clefts in the occluded vessels, and moderate to severe infiltration of lymphomonocytes and some eosinophils. Ten patients were followed up; renal function was normal in one patient and was insufficient in 9 patients, in which one died, and 8 patients showed no improvement in renal function. At the end of follow-up, 4 patients were dialysis-dependent. Conclusion The clinical manifestation of cholesterol crystal embolism varied. Renal biopsy and pathological examination
are required in unexplained acute or subacute renal insufficiency patients complicated with atherosclerosis, interventional therapy, and/or anticoagulant treatment.

Key words: Cholesterol crystal embolism, Renal injury, Renal biopsy