Renal atherosclerotic embolism

　　The incidence of renal embolism increases with age. The most important non-cardiogenic renal embolism is the ruptured aortic atherosclerotic plaque (atherosclerotic embolism). Renal atherosclerotic embolism may spontaneously occur during diffuse erosive atherosclerosis or secondary to vascular surgery, angioplasty, or arteriography.

　　Atherosclerotic emboli are typically non-inflatable, irregular in shape, and more likely to cause incomplete occlusion with secondary ischemic atrophy rather than renal infarction. Foreign body reactions often occur soon after, leading to intimal hyperplasia, giant cell formation and proliferation, and further vascular lumen narrowing. Pathological reactions may lead to progressive deterioration of renal function often within 3 to 8 weeks after atherosclerotic embolism.

　　1. The most common complication is renal parenchymal necrosis, which can lead to renal failure in severe cases, a pathological condition where part or all of the renal function is lost. It manifests as abnormal findings such as proteinuria, azotemia, oliguria, polyuria, dehydration, hematuria, metabolic acidosis, hyperkalemia, and severe impairment of overall health due to involvement of other organs.

　　2. Secondly, embolism often affects other abdominal organs (such as the pancreas, gastrointestinal tract) and others.

　　Renal arterial atherosclerotic栓塞 should be suspected in patients with idiopathic renal failure over the age of 60, especially when there are signs of progressive atherosclerosis. This disease is often insidious, lacking the clinical features of renal infarction, and the exact time of embolism formation in patients with spontaneous atherosclerotic栓塞 is difficult to determine compared to those after vascular surgery, angioplasty, angiography, or anticoagulant therapy (such as warfarin, fibrinolytic drugs).

　　Diagnosis may be difficult in patients with spontaneous disease or atypical clinical manifestations. In some patients, hematuria may be present in the urine sediment, and a few may have red blood cell casts. With these manifestations, acute glomerulonephritis or vasculitis should be suspected, especially if extrarenal manifestations are present, as renal arterial atherosclerotic栓塞 may be confused with polyarteritis due to the involvement of multiple organs. Percutaneous renal biopsy may detect about 75% of cases, with cholesterol crystals in the embolus dissolving during tissue fixation, showing pathologically characteristic bilobed, needle-like fissures in the occluded vessels.

　　1. Control calories:The intake of calories must be balanced with the expenditure of calories. This balance should be maintained within the standard weight range through a reasonable balance of diet and strengthening physical activity.

　　2. Low-fat diet:Reduce the intake of animal oil and replace it with vegetable oil, such as soybean oil, peanut oil, corn oil, etc., with a recommended amount of 25 grams per person per day, and no more than 750 grams per month. The cholesterol content in food should be limited, with no more than 300 milligrams per person per day. The fat content in egg yolks and animal organs such as liver and kidney is high, and they should be consumed less.

　　3. Low-salt diet:Patients with atherosclerosis often have hypertension, so a low-salt diet should be adopted, with no more than 5 grams of salt per day, and salt can be sprinkled on the cooked dishes for mixing. If salt is added during cooking, the cooked dishes may still be very bland and difficult to eat. To increase appetite, some vinegar, tomato sauce, or sesame paste can be added when stir-frying. Vinegar, in addition to flavoring, can promote digestion and absorption, and sesame paste is rich in calcium, which can supplement calcium when consumed regularly. Calcium ions can increase the density of vascular endothelium, which is beneficial for preventing cerebral hemorrhage.

　　4. Pay attention to hydration:Reduce the intake of sugary drinks and increase the consumption of natural beverages and water, especially in the morning and evening. The greatest benefit of drinking water is that it can dilute the blood and prevent vascular thrombosis.

　　5. Appropriate exercise:It is not enough to pay attention to dietary adjustment to completely prevent the occurrence of atherosclerosis. Appropriate exercise is also needed. Health checks should be conducted to ensure that there are no other abnormalities in the body before starting with more moderate activities such as walking and strolling. Further, walking and jogging can be done, gradually transitioning to continuous jogging, climbing, swimming, and other sports.

　　Most patients with spontaneous renal arterial atherosclerotic栓塞 are characterized by azotemia and progressive renal failure, while those with atherosclerotic thrombosis after vascular procedures may develop acute oliguric renal failure. Renal failure patients usually do not have symptoms related to the kidneys, although angiotensin II-mediated hypertension may occur in some cases. Urinalysis is often benign with微量proteinuria, but occasionally nephrotic range proteinuria may occur, with eosinophilia, eosinophiluria, and transiently low complement levels in the acute phase.

　　Embolism often affects other abdominal organs (such as the pancreas, gastrointestinal tract), and widespread peripheral embolism signs (such as reticulate mottling, painful muscle nodules, obvious gangrene) strongly suggest a diagnosis, but they do not always appear. Retinal embolism can lead to sudden blindness, and orange spots can be seen in the small arteries of the retina during fundus examination.

　　1. Low-fat Diet:Reduce the intake of animal oil and replace it with vegetable oil, such as soybean oil, peanut oil, corn oil, etc., with a recommended amount of 25 grams per person per day, and no more than 750 grams per month. The cholesterol content in food should be limited, with no more than 300 milligrams per person per day. The fat content in egg yolks and animal organs such as liver and kidney is high, and they should be consumed less.

　　2. Low-salt Diet:Patients with atherosclerosis often have hypertension, so a low-salt diet should be adopted, with no more than 5 grams of salt per day, and salt can be sprinkled on the cooked dishes for mixing. If salt is added during cooking, the cooked dishes may still be very bland and difficult to eat. To increase appetite, some vinegar, tomato sauce, or sesame paste can be added when stir-frying. Vinegar, in addition to flavoring, can promote digestion and absorption, and sesame paste is rich in calcium, which can supplement calcium when consumed regularly. Calcium ions can increase the density of vascular endothelium, which is beneficial for preventing cerebral hemorrhage.

　　There is no treatment that can reverse progressive renal failure. During surgical treatment of atherosclerotic aorta, the possibility of renal artery atherosclerotic embolism can be reduced by careful operation.

　　Acute Obstruction of Renal Artery:Once a diagnosis is confirmed for conditions such as blood clot embolism, immediate surgery should be performed. Under the guidance of a dual-function Doppler ultrasound, a catheter can be inserted into the renal artery embolism site through PTA percutaneous transluminal angioplasty and anti-thrombotic agents or fibrinolytic agents such as sodium alginate, alteplase (recombinant tissue plasminogen activator), or urokinase can be injected. After dilution, they are directly injected in the hope of dissolving the thrombus. If this fails, surgery should be performed immediately to incise the artery wall and remove the thrombus. Postoperative administration of anti-coagulant drugs such as aspirin is recommended.