Kidney Week

Abstract: SA-PO0382

Recurrent Acute Bilateral Kidney Infarction in the Setting of Kidney-Limited Vascular Abnormalities

Session Information

• AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Raja, Mohummad Hassan Raza, Duke University School of Medicine, Durham, North Carolina, United States

Mohummad Hassan Raza Raja, MBBS

• Safdar, Komal, Duke University School of Medicine, Durham, North Carolina, United States

Komal Safdar, MD

• Solomon, Alex Joseph, Duke University School of Medicine, Durham, North Carolina, United States

Alex Joseph Solomon, MD

• Gilmore, Brian, Duke University School of Medicine, Durham, North Carolina, United States

Brian Gilmore, MD

• Faison, Maya, Duke University School of Medicine, Durham, North Carolina, United States

Maya Faison, MD

• Middleton, John Paul, Duke University School of Medicine, Durham, North Carolina, United States

John Paul Middleton, MD

• Sparks, Matthew A., Duke University School of Medicine, Durham, North Carolina, United States

Matthew A. Sparks, MD, FASN

Introduction

Causes of acute kidney infarction, include cardioembolic disease, hypercoagulable states, vasculitis & vascular disorders such as fibromuscular dysplasia (FMD), arterial dissection & segmental arterial mediolysis (SAM). We report a case of successive bilateral kidney infarctions due to renal artery dissection with multifocal vascular abnormalities in a woman without evidence of autoimmune, hypercoagulable, or embolic disease.

Case Description

A 50-year-old woman presented with acute right flank pain. CT imaging showed right renal cortical hypoenhancement consistent with infarction. CT angiography demonstrated duplicated right renal arteries with focal narrowing concerning for dissection, FMD, or vasculitis. Despite anticoagulation & corticosteroids, she developed contralateral flank pain, rising inflammatory markers, hypertension & new bilateral renal infarcts with new left renal arterial narrowing & occlusions seen on repeat imaging. Evaluation including echocardiography, hypercoagulable testing, autoimmune serologies, infectious studies & rhythm monitoring was unrevealing. Catheter angiography demonstrated stenosis, aneurysm & dissection of an accessory right renal artery with bilateral perfusion defects. Multidisciplinary review favored SAM over FMD or vasculitis given focal dissection, aneurysm formation & isolated renal involvement. She remained clinically stable on prednisone taper, anticoagulation & antiplatelet therapy with stable kidney function on follow-up.

Discussion

This case highlights the diagnostic overlap among kidney vasculopathies, requiring multidisciplinary evaluation. In the absence of definitive histopathology, the pattern of multifocal infarction with angiographically preserved lumens and stable follow-up favored SAM, underscoring the importance multidisciplinary management in rare kidney vascular disorders.