Low-dose prednisolone ameliorates acute renal failure caused by cholesterol crystal embolism

Clin Nephrol. 2006 Oct;66(4):232-9. doi: 10.5414/cnp66232.


Aims: The prognosis of renal cholesterol crystal embolism (CCE) is poor. Although various treatments for CCE have been attempted, there is no optimal therapy. We tested the effect of low-dose prednisolone (PS) on CCE-related acute renal failure (ARF).

Patients and methods: 7 patients (mean age 69 years) diagnosed with CCE-related ARF were treated with oral PS at 15-20 mg/day for 2-4 weeks, which was then tapered at 5 mg/day over 2-4 weeks, followed by 5 mg/day maintenance dose. Recurrent ARF during PS tapering was treated with a larger dose of PS.

Results: Inciting factors were identified in four patients: coronary angiography (n=3) and cerebral angiography (n=1). On admission, serum creatinine (SCr) was 2.1 +/- 0.3 mg/dl (mean +/- SEM). SCr and eosinophil count before treatment were 4.2 +/- 0.4 mg/dl and 682 +/- 73/microl, respectively. PS therapy improved ARF in all cases at week 2 (SCr 3.8 +/- 0.5 mg/dl) parallel to a decrease in eosinophilia (116 +/- 30/microl), and at week 4 (3.1 +/- 0.4 mg/dl and 134 +/- 20/microl, respectively). At last follow-up, renal function was improved or maintained in 5 patients compared with that at week 4 post-treatment. One patient died of lung cancer. Another required LDL apheresis and hemodialysis but died due to CCE-related multi-organ failure. A third patient had recurrent ARF and was re-treated with a larger dose of PS, which resulted in an immediate decrease in SCr. However, the patient developed acute renal dysfunction due to congestive heart failure, and required hemodialysis.

Conclusions: Low-dose PS improved CCE-related ARF, probably through amelioration of inflammatory reaction surrounding affected renal vessels.

MeSH terms

  • Acute Kidney Injury / drug therapy*
  • Acute Kidney Injury / etiology*
  • Aged
  • Aged, 80 and over
  • Dose-Response Relationship, Drug
  • Embolism, Cholesterol / complications*
  • Embolism, Cholesterol / drug therapy*
  • Embolism, Cholesterol / pathology
  • Female
  • Humans
  • Kidney / blood supply
  • Kidney / pathology
  • Male
  • Middle Aged
  • Prednisolone / administration & dosage*
  • Skin / blood supply
  • Skin / pathology
  • Treatment Outcome


  • Prednisolone