Two weeks after undergoing an emergency cardiac catheterization for unstable angina pectoris, a 65-year-old man has decreased urinary output. He takes naproxen for osteoarthritis and was started on aspirin, clopidogrel, and metoprolol after the coronary intervention. His temperature is 38.1°C (100.5°F), pulse is 96/min, and blood pressure is 128/88 mm Hg. Examination shows mottled, reticulated purplish discoloration of the feet and ischemic changes on the right big toe. His leukocyte count is 16,500/mm3 with 56% segmented neutrophils, 12% eosinophils, 30% lymphocytes, and 2% monocytes. His serum creatinine concentration is 4.5 mg/dL. A photomicrograph of a kidney biopsy specimen is shown. Which of the following is the most likely cause of this patient's presentation?
- A)Allergic interstitial nephritis
- B)Cholesterol embolizationGABARITO
- C)Contrast-induced nephropathy
- D)Renal papillary necrosis
- E)Eosinophilic granulomatosis with polyangiitis
Explicação
Cholesterol embolization syndrome occurs when cholesterol crystals dislodge from atherosclerotic plaques and enter the bloodstream, obstructing small to medium-sized arteries. Incidence is highest in older individuals with underlying atherosclerosis, particula... Ver explicação completa e trilha adaptativa →