Hemodialysis and high-dose steroids can salvage renal function in cholesterol crystal embolization: Acute kidney injury secondary to microemboli to a solitary kidney during aortic endovascular aneurysm repair.

A 66-year-old woman with a solitary right kidney with renal artery stenosis and a 5.0-cm abdominal aortic aneurysm underwent renal artery stenting followed by endovascular aortic aneurysm repair endovascular aneurysm repair 1 month later. She developed rapidly progressive renal failure and recurrent hypertension despite a patent renal stent. A renal biopsy revealed cholesterol crystal emboli with focal segmental glomerulosclerosis, supporting the diagnosis of atheroembolic kidney disease. High-dose methylprednisolone followed by a 5-week prednisone taper and temporary hemodialysis led to dialysis independence and blood pressure control within 2 months. Biopsy-driven diagnosis, hemodialysis, and pulse corticosteroid therapy may reverse atheroembolic renal injury, especially in vulnerable patients with a single kidney.