A 76-year-old man without any prior history of abnormal urinalysis findings or
renal insufficiency demonstrated mild renal dysfunction after coronary bypass graft surgery (CABG). Two months after CABG,
pain and blueness in the toes (
blue toe syndrome) appeared and, the serum
creatinine level (S-Cr) increased from 1.2 to 2.0 mg/dL. On admission (3 months later), the urinary
protein level was 0.5 g/day, white blood cell count 8,300/microL with eosinophils (Eo) 10.5%, S-Cr 2.1 mg/dL, and
low-density lipoprotein (
LDL) 106 mg/dL.
Acute renal failure and
blue toe syndrome due to a
cholesterol embolism (CE) were diagnosed.
Alprostadil 40 microg/day orally for 2 weeks and
alprostadil 40 microg/day intravenously were used for 5 weeks, and Eo were 250/microL, S-Cr 2.5 mg/dL; however,
blue toe syndrome gradually developed. At 8 weeks after admission,
limaprost alfadex 30 microg/day orally was used for 3 weeks. However, the Eo gradually rose to 1,520/microL, S-Cr to 3.0 mg/dL, and
LDL to 135 mg/dL, and
LDL apheresis was therefore performed 20 times for CE. The data just after
LDL apheresis was performed 10 times were as follows: Eo 1,120/microL, S-Cr 4.0 mg/dL, and
LDL 89 mg/dL, and
blue toe syndrome had disappeared.
At 10 months after the first
LDL apheresis, the Eo were 630/microL, S-Cr 2.9 mg/dL, and
LDL 109 mg/dL. As a result,
LDL apheresis was found to be beneficial for the treatment of CE with
acute renal failure and
blue toe syndrome after CABG.