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Kidney Week

Abstract: PO0107

Renal Artery Thrombosis in a Patient Homozygous for Plasminogen Activator Inhibitor-1 4G Allele

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Santana Martinez, Frank S., American College of Physicians, Philadelphia, Pennsylvania, United States
  • Mehta, Siddharth, American College of Physicians, Philadelphia, Pennsylvania, United States
  • Poudel, Shyam K., American College of Physicians, Philadelphia, Pennsylvania, United States
  • Shah, Parth Rajeshbhai, American College of Physicians, Philadelphia, Pennsylvania, United States
Introduction

Renal artery thrombosis is a serious, uncommon, and often undiagnosed condition. Physicians need to consider this diagnosis in unexplained flank pain, especially in the presence of risk factors. Plasminogen activator inhibitor-1 (PAI-1) is the major inhibitor of tissue-type plasminogen activator. Fibrinolysis is impaired due to increased plasma PAI-1 levels which play an important role in the pathogenesis of thrombotic disorders. Homozygous for the 4G allele had increased plasma PAI-1 concentrations.

Case Description

A 53 years old male smoker with hypertension, presented to the emergency room complaining of abdominal pain and pink urine for 3 days. His BP was 186/120 mmHg and pulse 100/min. Physical exam was consistent with right flank tenderness. Urinalysis showed high gravity, high amount of protein, glucose, and blood. Creatinine was 1.6 and the baseline was unknown. CTA showed right renal artery occlusion. The patient was transferred to CCU and started on clevidipine and heparin drip. Arteriogram and directed thrombolysis were performed. Despite these interventions, his creatinine trend peaked at 2.85, whereas hemoglobin started dropping substantially. High rate IV fluids, a workup for malignancy, and hypercoagulable were started with subsequent stent placement for reperfusion. After 3 days of directed thrombolysis, he was transferred to wards. Urine output decreased and a Foley catheter was placed. the patient was started on clonidine, amlodipine, and labetalol. After 10 days of hospitalization, all workup was unremarkable. PAI-1 4G/5G study was homozygous for 4G allele. The patient’s medical condition improved. He was discharged and advised to follow up as an outpatient.

Discussion

Studies have proven the link between PAI-1 4G and thrombotic events, however, most of the evidence shows a link between PAI-1 4G and venous thrombosis. In this patient, the fact of him being homozygous for PAI-1 4G allele led to arterial thrombosis. Therefore, it might be prudent to include a PAI-1 workup in prothrombotic studies. In renal artery thrombosis, a cause must be established. Although there are other common causes of arterial thrombosis, PAI-1 4G should be considered as a potential cause in patients with few or no risk factors. This case report glimpses the relationship between an uncommon genetic mutation and a rare diagnosis.