Cholesterol emboli syndrome laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
== Laboratory Findings == | == Laboratory Findings == | ||
* | *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> | ||
**Tests for [[inflammation]] ([[C-reactive protein]] and the [[erythrocyte sedimentation rate]]) are typically elevated | |||
**abnormal [[liver enzyme]]s | |||
* | **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="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> | ||
* | **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 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> | ||
* | |||
* | |||
* 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 === | ||
* | *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 | ||
* | * [[Hematuria]] | ||
* [[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
- Laboratory findings consistent with the diagnosis of Cholesterol emboli syndrome include[1][2]
- Tests for inflammation (C-reactive protein and the erythrocyte sedimentation rate) are typically elevated
- abnormal liver enzymes
- 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 eosinophils (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.[3]
- Examination of the urine may show red blood cells (occasionally in 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 syndrome, limiting the use of this test in the distinction between vasculitis and cholesterol embolism syndrome.[4]
- If Organ damage occurs, laboratory findings include
- Renal failure - increased serum creatinine and BUN greenberg
- Myocardial infarction - serum creatine kinase (CPK) and troponin elevation
- Mesenteric ischemia - Bloody (OB+) stool common
Biomarker Studies
- increased ESR and CRP
- Peripheral eosinophilia moolenaarneth
- eosinophiluria - usually in patients with cholesterol-renal disease
- Hematuria
- proteinuria
- May have leukocytosis (even >20K/µL) with left shift
- Hypocomplementemia is common
- Thrombocytopenia due to aggregation and complement activation
References
- ↑ 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. - ↑ 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.
- ↑ 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.
- ↑ 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)