A 70-year-old diabetic and hypeensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfo and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a pre-angiography level of 1.2 to 3.6 mg/dl. He has eosinophilia. Which one of the following statements is TRUE regarding this condition?
Diabetes and angina both point to atherosclerosis. In patients undergoing angiography, catheterization can lead to embolism of a vulnerable atherosclerotic plaque in descending aoa downstream to renal aeries leading to an atheroembolic kidney disease. The symptoms of diabetic patient developed after angiography and since atherosclerotic lesion can involve the aoa, the atheroembolic event would explain the events. Presence of eosinophilia and mottling of toes and reduced kidney function confirm the diagnosis as Atheroembolic kidney disease. Hence Choice D is the answer. Lab findings include Rising serum creatinine Transient eosinophilia Elevated sedimentation rate Hypocomplementemia Definitive diagnosis by doing kidney biopsy:- Microvessel obstruction with cholesterol crystals that leave a cleft in the vessel. Contrast-induced nephropathy can occur in diabetics with chronic kidney disease. However rash, toe discoloration with the sudden rise of creatinine and eosinophilia are not seen in contrast-induced nephropathy. Hence choice B is ruled out Choice A is ruled out as it prevents contrast-induced nephropathy Choice C is ruled as out as heparin will not manage cholesterol embolism
N-acetylcysteine would have prevented this condition
This is contrast-induced nephropathy
Heparin is the treatment of choice
Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel
Chronic Kidney Disease & Diabetic Nephropathy