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Kidney Week

Abstract: SA-PO767

Spontaneous Renal Artery Dissection

Session Information

  • Hypertension and CVD: Mechanisms
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

  • 1503 Hypertension and CVD: Mechanisms

Authors

  • Aljassani, Khaldoon, UPMC, Pittsburgh, Pennsylvania, United States
  • Ali, Rimsha, UPMC, Pittsburgh, Pennsylvania, United States
  • Mirza, Taaha Muddassir, UPMC, Pittsburgh, Pennsylvania, United States

Group or Team Name

  • University of Pittsburgh Medical Center
Introduction

Renal artery dissection is frequently seen as an extension of aortic dissection, but bilateral Spontaneous Renal Artery Dissection (SRAD) is an extremely rare condition that has only been described in case reports. The clinical presentation is variable and renal infarction is a frequent consequence.

Case Description

A 41-year-old male with insignificant past medical history presented with a sudden onset left sided sharp flank pain, 7/10 in intensity, non-radiating,no dysuria, hematuria, frequency. His routine labs on presentation were benign apart from mild elevation in white blood cell count and elevation of creatinine from baseline.
CT abdomen with contrast showed left kidnyinfarction with large thrombus in the left renal artery. Coagulation profile and thrombophilia work up was negative.
Heparin infusion was started,the patient’s pain and renal function improved, discharged on apixaban.
3 days later he presented with right flank pain with hematuria, face puffiness and lower limb swelling, hypertension.
Initial work up showed elevated creatinine,ESR and CRP, LDH, D dimer,mild transaminitis.
CT abdomen and pelvis with contrast showed parital right kidney infarct with filling defect in the right renal artery
suspicious for a dissection.
Patient was started on heparin infusion, steriods and azathioprine.
Further autoimmune work up was negative.
Peripheral smear, bone marrow biopsy, MRI angiography of the head and neck was normal.
IR angiogram of the renal arteries showed bilateral renal artery dissection. A stent was placed in the
right renal artery, improving right renal blood flow to the residual right renal parenchyma. No
significant flow was identified in the left renal artery.

Discussion


SRAD is a rare phenomenon with incidence of 0.05% of all artery dissections (1). Spontaneous bilateral renal artery dissection is an exceedingly rare condition described in case reports. (2, 3) The etiology has not been clearly defined; however Fibromuscular Muscular Dysplasia is noted to be associated with the development of SRAD, which is what we expected as the likely cause in our patient. The presentation of SRAD is variable, usually asymptomatic (C), unless it leads to renal infarction. A CT angiogram can be used to diagnose renal artery dissection as with most dissections. Treatment focused is on surgical revascularization and nephrectomy is only opted for if there is a high infarction burden.