Traumatic Bilateral Renal Artery Thrombosis: A Case of Kidney Salvage with Local Lytic Therapy and Systemic Anticoagulation in the Setting of Poly-trauma

Abstract

We present a case of acute blunt traumatic bilateral renal artery thrombosis in the setting of multisystem trauma. Catheter-directed thrombolysis with tissue plasminogen activator afforded kidney salvage with return of glomerular filtration rate to normal values at the time of patient discharge. included a small left subdural hematoma, a left hemothorax and lung contusion. Bilateral renal infarctions with traumatic renal vascular thrombosis, and a right renal pelvis tear with minimal contrast extravasation was demonstrated. The remaining abdominal viscera were without acute injury. The right renal infarct was extensive compared to the left and involved the majority of the right kidney (Figure 1). A visceral angiogram confirmed bilateral renal infarctions, greater in the right kidney. The thrombus on the right renal artery was large and extending to several interlobar arteries (Figure 2). A catheter was placed in the right main renal artery for infusion of tissue plasminogen activator (TPA) at 2 mg/hr for four hours after an initial bolus of 8 mg for a total dose of 16 mg. The time from injury to the treatment with TPA was approximately 5 hours. The patient was also placed on systemic heparin drip due to the bilateral nature of the renal artery thrombosis. This decision was made following consultation with a neurosurgeon as the patient also had an acute subdural bleed. A collaborative decision was reached to proceed with