Renal Artery Thrombosis

Abstract

The diagnosis of acute renal infarction is often delayed or failed due to the rarity of the disease and to its non-specific clinical presentation. Cigarette smoking, with its vasoconstrictive and prothrombotic effects, is a known and sure risk factor for the development of the atheroembolic artery disease. Case study This is the report of a case of acute renal infarction in a heavy-smoking patient, a 66-year-old man who arrived at our ward for right worsening backache with vomit and abdominal pain not reacting to the analgesic therapy. A urgent ultrasound showed excretory axes not dilated bilaterally. Therefore, we had to perform further diagnostic tests (CT and then angiography) which highlighted a case of a right massive renal infarction due to complete thrombotic obstruction of the renal artery with patent contralateral ramification. We performed a PTA and then a local infusion of thrombolytic (metalyse 2 mg in 10’). After this treatment the patient showed an immediate stop of the hurting symptomatology, an improvement of the flow and an opacification of the parenchyma. (lower and medium part) with persistence of vision concerning endoluminal thrombosis. A CT angiography 20 days later, after home therapy with LMWH at therapeutic doses, confirmed a restored and normalized vascularization of the lower and medium part of the right kidney. Conclusions In the light of these case results - good revascularization of the lower 2/3 of the right kidney, despite a prolonged time of ischemia from the beginning of the symptoms to the diagnosis and to the further thrombolytic therapy (about 14 hours) -, we assume that a wider use of the Doppler method can be of some usefulness, in case of recurring colics especially not reacting to analgesic therapy with negative ultrasonography check-up for the dilatation of the excretory routes, in order to considerably reduce the diagnosis time of renal diseases of vascular type.