Abstract: PUB009
Severe AKI with Aortoiliac Occlusion and Bilateral Renal Artery Stenosis with Improvement After Surgical Repair
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ijaduola, Ewalola A., Morehouse School of Medicine, Atlanta, Georgia, United States
- Bashir, Khalid, Morehouse School of Medicine, Atlanta, Georgia, United States
Introduction
Renal artery stenosis can be associated with aortic thrombus and atherosclerotic plaques originating in the aorta that extend into the renal arteries.
Case Description
We report a case of a 48-year-old man with a history of hypertension, chronic kidney disease stage 3, Serum creatinine 1.48mg/dl, who was admitted with hypertensive crises, paroxysmal nocturnal dyspnea for 3 days, with severe acute kidney injury. He has had uncontrolled hypertension for the past year despite medication compliance. He had smoked four cigarillos daily for 20 years. Laboratory data revealed blood urea nitrogen of 62mg/dL and creatinine of 4.3 mg/dL, with an echocardiogram showing a large circumferential pericardial effusion with tamponade, requiring pericardiocentesis. Renal ultrasound showed an echogenic small right kidney 8.9cm, and left kidney 9.5cm. Renal duplex ultrasound showed less than 60% stenosis in the Right Renal artery with collateral filling and left renal artery stenosis greater than 60% with complete aortic occlusion. Computed tomography Angiogram of the abdominal aorta showed Aortoiliac occlusion just below the left renal artery but involving the origin of the right renal artery, with critical near-occlusive stenosis of the left renal artery and occluded right renal artery ostium. Operative vascular repair findings with chronic aortic thrombus extending into bilateral renal arteries requiring Aorto-femoral bypass bilaterally with aortic and renal artery thrombectomies. Postoperatively, urine output doubled, with a decrease in creatinine from 4.1mg/dL to 2.1mg/dL by postop day 7.
Discussion
Renal artery stenosis results in a decrease in renal perfusion with activation of the renin angiotensin aldosterone system, with renovascular hypertension and ischemic kidney injury. Chronic thrombus can lead to refractory hypertension with progressive renal impairment, while acute thrombi cause wedge infarcts. The association of Aortic thrombus and occlusion with bilateral renal stenosis, especially in our patient who had a juxta-renal aorto-iliac occlusion, must be emphasized to improve clinical diagnosis. Our patient’s Acute Kidney Injury was secondary to aortic thrombus occlusion with bilateral renal artery stenosis, with marked improvement following surgical repair, highlighting the importance of suspicion for vascular causes of Acute Kidney Injury in Hypertensive crises.