American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be expected in urinalysis in patients with cholesterol embolization?

1. Proteinuria

2. Hematuria

3. Eosinophiluria

4. Glucosuria

The correct answer is: Eosinophiluria

In patients with cholesterol embolization, the presence of eosinophiluria is a significant find in urinalysis. Cholesterol embolization occurs when cholesterol crystals from atherosclerotic plaques dislodge and travel through the bloodstream, ultimately causing damage to the renal microvasculature. This process can lead to a specific inflammatory response, characterized by the recruitment of eosinophils to the site of injury. The detection of eosinophils in the urine indicates an allergic or hypersensitivity reaction, commonly associated with the degenerated tissue and inflammation resulting from cholesterol crystals causing vascular occlusion. This response is part of the broader spectrum of renal manifestations seen in cholesterol embolization, which may also include acute kidney injury. While proteinuria, hematuria, and glucosuria can occur in various renal pathologies, they are not specific markers for cholesterol embolization. Proteinuria might be noted in cases of significant kidney involvement, hematuria can be a response to kidney injury from a variety of causes, and glucosuria typically indicates issues with glucose metabolism rather than vascular occlusion by cholesterol. Therefore, the presence of eosinophils identifying an allergic-type response is a hallmark of cholesterol embolization and is the most expected finding in ur