AERD results from atherosclerotic plaque, the source of cholesterol crystals. A diseased, atherosclerotic aorta is the most common cause of AERD. The syndrome is most often begins following direct mechanical injury to the plaque, causing the release of the cholesterol crystals into the blood stream. Thus, cardiac catheterization is a common precipitating factor, as is direct trauma during aortic surgery.

Thrombolysis or anticoagulation (a process of making the blood thin so as to avoid clot formation in some disease states) have been known to agitate the plaques and release cholesterol crystals. Rarely, the syndrome may occur spontaneously.

Once in the circulation, the crystals lodge in small blood vessels. As the aorta is the most common source of the crystals, the kidney, intestine and legs are at prime risk.

Once in the tiny blood vessels called arterioles, the crystals cause an intense inflammatory response. The end result is organ damage due to decreased blood supply. In the kidneys, this may lead to acute renal failure if the reaction is severe.

A spectrum of responses may be seen, though. These range from serious end stage renal disease, requiring dialysis, to only mild elevation in plasma creatinine (a test used to gauge kidney function).

The risk factors for AERD are the same as risk factors for atherosclerosis. This is a syndrome seen predominantly in elderly males with vascular disease.