Renal infarction following selective renal arteriography.

Abstract

Previous reports of the complications encountered during percutaneous catheter renal arteriography have been largely limited to an evaluation of bleeding and vascular problems encountered at the puncture site (1–6). The mishaps related to the passage of catheters and guide wires in the major vessels have been stressed. Renal damage, on the other hand, is a rarely reported complication of aortic and selective renal artery injections of contrast material. Isolated accounts of transient or permanent renal insufficiency following the aortic injection of large volumes of contrast material by either the translumbar or catheter technic have been recorded in the literature (7–10). Pathologic confirmation is available in some instances, demonstrating early changes consisting of hemorrhagic necrosis and edema (7–8). In cases evaluated roentgenographically for varying periods of time following injury reduction in renal size has been shown (8–9). While kidney damage after selective renal arteriography is well documented in experimental animals (11–14), there are few clinical reports evaluating this type of injury. The following report relates in detail the occurrence of a localized renal infarction in a 30-year-old woman subjected to selective left renal arteriography. Case Report C. J., a 30-year-old white female, was admitted to the Grace-New Haven Community Hospital, New Haven, Conn, for the evaluation of a mass in the left kidney. The present illness began two months prior to admission when treatment for acute hemorrhagic cystitis was instituted. The symptoms of cystitis cleared promptly, but intravenous pyelography demonstrated an abnormality in the lower pole of the left kidney. The previous medical history was noncontributory. Physical examination was entirely within normal limits except for the presence of external hemorrhoids. The blood pressure was 110/GO. The routine laboratory values including urinalysis were normal. Urine culture studies revealed no growth of pathogenic bacteria. A retrograde pyelogram (Fig. 1) confirmed the presence of a mass in the lower pole of the left kidney, distorting the collecting system in this area. Renal arteriography was performed to evaluate the vascular pattern of this lesion. With the Seldinger technic, a green Ödman selective catheter was passed into the aorta, following right femoral puncture. The catheter tip was placed in the left renal artery with minimal manipulation and advanced for a distance of 1 cm. A test injection of 3 cc of 50 per cent sodium diatrizoate was observed under the image amplifier. The contrast medium flowed directly into the renal parenchyma where it remained as a fixed density over a period of several minutes of observation (Fig. 2, A). The catheter was withdrawn to the orifice of the renal artery. A second test injection was carried out, which demonstrated momentary filling of a renal artery with a normal rapid wash-out of the contrast material.