Acute Renal Artery Research Articles

Successful emergency renal auto-transplantation in a child with renovascular disease.

Renal artery occlusion is a rare but potentially catastrophic complication of paediatric endovascular renal artery intervention. Emergency auto-transplantation may be required to salvage the kidney; to date this has only been described in adults. We report our experience of performing emergency kidney auto-transplantation following acute renal artery thrombosis in a child undergoing redo renal artery angioplasty A 20-month-old boy presented with refractory hypertension and hypertensive cardiomyopathy secondary to multifocal fibromuscular dysplasia (FMD) with a single functioning kidney. Acute thrombosis of the renal artery during redo-endovascular balloon angioplasty necessitated emergency renal auto-transplantation. Subsequent acute kidney injury was reversible with benefit to renal function in the medium-term despite prolonged warm ischaemic time of two hours. We recommend that high-risk patients undergoing renal artery intervention do so at centres with on-site renal and vascular surgical backup.

Flank pain, hypertension, and hematuria: CT and 3D cinematic rendering in the evaluation of renal artery emergencies-a pictorial essay.

Non-traumatic acute renal artery emergencies encompass a spectrum of etiologies, including renal artery stenosis, arteriovenous malformations, aneurysms and pseudoaneurysms, dissections, thrombosis, and vasculitis. Prompt and accurate diagnosis in the emergency setting is crucial due to the potential for significant morbidity and mortality. Computed tomography (CT) and CT angiography (CTA) are the mainstay imaging modalities, offering rapid acquisition and high diagnostic accuracy. The integration of 3D postprocessing techniques, such as 3D cinematic rendering (CR), improves the diagnostic workflow by providing photorealistic and anatomically accurate visualizations. This pictorial essay illustrates the diagnostic utility of CT and CTA, supplemented by 3D CR, through a series of 10 cases of non-traumatic renal artery emergencies. The added value of 3D CR in improving diagnostic confidence, surgical planning, and understanding of complex vascular anatomy is emphasized.

Rare Case of Acute Renal Artery Thrombosis in Nephrotic Syndrome: The Unusual Presentations and Outcomes of Endovascular Manual Aspiration Thrombectomy

Renal artery thrombosis is a rare condition that requires early diagnosis and urgent intervention to prevent renal infarction and permanent renal damage. Possibility of renal artery thrombosis should be considered in patients with underlying hypercoagulable state presented with acute unremitting flank pain, nausea and vomiting. We report a case of a 35-year-old man with underlying nephrotic syndrome who presented with three days history of acute non-localized and non-resolving abdominal pain and vomiting. He was initially referred to general surgery for acute intestinal obstruction. Contrast-enhanced computed tomography (CECT) abdomen revealed acute left renal infarction secondary to total thrombotic occlusion of the left renal artery. The patient was treated with endovascular manual aspiration thrombectomy resulting in partial revascularization of left renal artery with restoration of renal function, complete resolution of symptom and good clinical outcomes. This case report serves as a reminder for physicians to include renal infarction in the differential diagnosis when evaluating a patient with acute abdomen, particularly in patient with hypercoagulable state. This case also aligns with other experiences demonstrating positive outcomes after endovascular thrombectomy, even in the presence of prolonged renal ischemia time of more than 72 hours.

The Key to Treating Acute Renal Artery Thrombosis

The Key to Treating Acute Renal Artery Thrombosis

Rarely Seen Vascular Complication After Treatment in a Covid-19 Patient: Renal Artery Thrombosis

Although respiratory symptoms are dominant in COVID-19 (coronavirus disease-2019) infection, extrapulmonary systemic findings may be seen in the extremely sick group. Studies are showing that patients have a high incidence of arterial and venous thrombotic complications in COVID-19. Acute renal artery thrombosis represents a rarer type of arterial thromboembolism, even among the thrombotic complications of COVID-19 disease. Such complications appear especially during the active phase of the infection. In this article, a rare case of renal artery thrombus in a discharged patient after treatment for COVID-19 pneumonia despite prophylactic antithrombotic treatment is offered.

Akut Renal Arter Kanamalarında Endovasküler Tedavi: Etkinliği ve Böbrek Fonksiyonlarına Etkisi

Aim: The aim of this study was to investigate the efficacy and complications of endovascular treatment of acute renal artery hemorrhage and the etiology of the condition. Material and Methods: Twenty-two patients who underwent endovascular embolization with renal acute artery hemorrhage between 2016 and 2020 were evaluated retrospectively. Etiologies of the acute renal artery hemorrhage were investigated. Laboratory and clinical follow-up information were analyzed for the efficacy and the complication of the treatment. The serum creatinine levels of the patients before and after the procedure were compared. Results: Selective renal artery embolization procedures were performed in a total of 22 patients. Of the 22 patients, 10 (45.5%) were male and 12 (54.5%) were female. The patients' ages ranged from 5 to 79 years, and the mean age of the patients was 51.5±18.6 years. Clinical success was achieved in 91.7% of embolization procedures. A statistically significant increase was seen in the serum creatinine levels of the patients after the procedure compared to 24 hours before the angiography procedure (median: 0.97 vs. 0.93, p=0.046). No significant change was observed in serum blood urea nitrogen and the estimated glomerular filtration rate levels (p=0.338, and p=0.067, respectively). Acute renal failure and postembolization syndrome were observed in only one patient as complications. The complication rate was found to be 4.5%. Conclusion: Selective embolization of the renal artery has high clinical success in acute renal artery hemorrhages without impairing renal function. The treatment has advantages such as no need for general anesthesia, and low complication rates.

Endovascular Treatment of post-traumatic Renal Artery Dissection.

Blunt renal artery injuries are rare, and no single trauma center has accumulated sufficient experience to draw meaningful conclusions or recommendations about optimal therapeutic strategies.[1]
 The increased use of CT scans to evaluate blunt abdominal trauma identifies more acute renal artery injuries that may have gone undetected.[2]
 Patients with renal injury have limited options such as open surgical repair or anticoagulation.[3] The use of endovascular stents to treat trauma is a good option treatment. [4] But not every case is successful.
 The purpose of this case report is to describe the importance of accurate diagnosis and successful repair in emergency traumatic conditions by means of interventional radiology in cases of intimal damage to the renal arteries.
 We will present a 38-year-old man who shows on the emergency room because of an accident with abdominal and thoracic trauma. The patient complained of pain in the right side of the abdomen…
 Through Angiography, an intimal dissection localized in the upper pole of the right kidney was confirmed. We inserted an expandable balloon stent using a transfemoral approach to successfully repair the dissection.
 Conclusion: Blunt renal artery injury is rare. Nonoperative management should be considered an acceptable therapeutic option. Management of blunt renal injuries includes timely evaluation to maximize the preservation of renal function. Recent management trends support the consideration of endoluminal intervention for traumatic renal artery dissections.

Инфаркт почки. Анализ 12 случаев острой окклюзии почечной артерии.

Introduction. Kidney infarction (KI) is a rare condition that most often develops as a result of renal artery thromboembolism and causes complete or partial loss of renal function. The diagnosis of this pathology is challangable. Objective. To analyze the features of diagnosis, clinical, laboratory and instrumental characteristics of renal infarction. To assess delayed changes in the renal parenchyma in patients with renal infarction. Materials and methods. Retrospective analysis of data from 12 patients with KI who were admitted to V.M. Buyanov Moscow City Clinical Hospital from 2018 to 2021 and consequent prospective analysis of the results of examination of these patients between 2 and 34 months after KI were done. Result. The mean age of the patients was 60,4 years. Eight patients were admitted to the hospital with surgical diagnoses. None of the patients was correctly diagnosed in the first 12 hours from the onset of the disease. Seven patients had atrial fibrillation. The most informative diagnostic method was contrastenhanced renal computed tomography (CT) scan. The average lactate dehydrogenase (LDH) level was 1563,4 U/L, creatinine - 149,5 μmol/L. Discussion. Evaluation of functioning parenchyma during the control examination showed that it volume was equal to volume of the parenchyma not involved in the infarction at the time of primary hospitalization. Delayed investigation also showed mild violation of the evacuation function on the affected side. Conclusions. Atrial fibrillation is the main risk factor for renal infarction development. Contrast-enhanced CT remains the most valuable method for detecting acute renal artery occlusion. Late diagnosis of the infarction is the main reason of futility of endovascular correction. It requires vigilance of urologists and surgeons in relation to this problem.

MO355: Recovering From a Renal Vascular Catastrophe

Abstract BACKGROUND AND AIMS Bilateral acute renal artery thrombosis (BARAT) is a rare and catastrophic condition. This diagnosis is often delayed or unrecognized and the true incidence may be underestimated. To the best of our knowledge, only three cases are reported in literature—all treated conservatively. We present two cases of BARAT who recovered kidney function under conservative approach. METHOD Data was obtained from the electronical medical record. RESULTS: Case 1:A 73-year-old male with no history of cardiac disease, hypertension or recent trauma was admitted with right flank pain and vomiting. He had severe hypertension (204/103 mmHg), anuria with acute kidney injury (AKI) and elevated lactate dehydrogenase (LDH). He started haemodialysis on admission. Renal computerized tomography (CT) angiogram showed bilateral arterial thrombosis—left renal artery was totally occluded and partial occlusion of the right renal artery with slight enhancement of the corresponding kidney (Fig. 1). Vascular surgery posed no surgical indication and systemic anticoagulation with low molecular weight heparin (LMWH) was started. A thorough screening for occult neoplasm and hypercoagulable state causes was negative. He was independent from dialysis 54 days after. Currently (6 months after), he is on stage 3b chronic kidney disease (CKD) with a serum creatinine (sCr) 2.19 mg/dL. Case 2: A 65-year-old female was admitted with dyspnea associated with right lumbar pain, severe hypertension (230/140 mmHg), peripheral edema and pulmonary congestion. Her prior history included heavy smoking and atherosclerotic artery disease with placement of aortoiliac stent 20 years before. She had no history of atrial fibrillation. She was admitted with de novo cardiac insufficiency with a mild reduction of left ventricular ejection fraction. After admission, she developed anuric AKI with refractory fluid overload and started dialysis. CT angiogram showed a large aortic thrombus that occluded both renal arteries. The right principal renal artery was occluded but the kidney had partial reperfusion from an accessory artery (Fig. 2). The left renal artery was totally occluded. Vascular surgery posed no surgical indication and the patient started LMWH. She was independent from haemodialysis 30 days after. She has currently a stage 4 CKD with sCr 3.2 mg/dL. CONCLUSION There are currently no guidelines on both the acute and long-term management of BARAT. The few reported cases of BARAT were all treated conservatively with systemic anticoagulation and had late but consistent kidney function recovery. This suggests that renal parenchyma could still be viable after BARAT. Could early revascularization therapies accelerate recovery and minimize irreversible damage? In both cases, a cause was not found. Much is still unknown about the pathophysiology, and further research is warranted.

Kidney infarction in patient with covid-19: clinical case

Abstract Description: A 50-year-old male who was admitted to intensive care with a Coronavirus-19 diagnosis for strict handling requiring oxygen therapy. He presented distention and abdominal pain, for which an abdomen-pelvic tomography was requested, reporting lack of filling in the right renal artery and renal infarcts requiring angioplasty and double antiplatelet therapy. The evolution was favorable, and the patient was discharged. Currently, a renal Doppler reports adequate vascularization. The patient presents proper renal function. Clinical Significance: The coronavirus disease is a contagious and life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2. It can lead patients to arterial and venous thrombosis. However, acute renal artery occlusion is considered a rare disease. Clinical Implications: Prompt diagnosis and treatment are important to prevent permanent kidney damage or permanent loss of kidney function. Conclusion: The underlying etiology of renal infarcts remains largely unknown at present, but it may include direct viral cytopathic effects on endothelial cells. Most patients are managed conservatively. Some cases undergo angioplasty successfully. The patient in this case received earlier treatment with doses of anticoagulant enoxaparin, and his glomerular filtration remained stable, although complementary treatment was required.

Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

Precipitous AKI due to Acute Renal Artery Thrombosis in a Patient with Protein S Deficiency

Precipitous AKI due to Acute Renal Artery Thrombosis in a Patient with Protein S Deficiency

Sympathetic responses during renal artery occlusion are altered by anesthesia

Sympathetic hyperactivity contributes to stenotic renovascular hypertension. Transient or prolonged reduction in renal perfusion or renal artery occlusion activates renal sensory fibers to alter renal hemodynamics. Electrical stimulation of these fibers increases sympathetic nerve activity (SNA) and arterial blood pressure (ABP). Recently, we demonstrated that anesthetic agents differentially impact renal afferent sensitivity to mechano- and/or chemical-stimuli, including acute renal artery occlusion. The purpose of the present study was to assess the extent by which anesthesia affects efferent sympathetic reflex responses to renal artery occlusion. Renal, splanchnic, and lumbar SNA were measured during transient renal artery occlusion (3 min) in male and female Sprague-Dawley rats (250-400g) using unanesthetized decerebrate preparations, Inactin, isoflurane, or urethane anesthesia. Baseline ABP was significantly higher for decerebrate (122±8 mmHg) and urethane (133±6 mmHg) groups versus Inactin (78±3 mmHg) and isoflurane (95±4 mmHg; p=0.0001). Within the initial 30 seconds, renal artery occlusion decreased mean ABP in decerebrate (Δmean ABP= -13±3 mmHg; n=8; 5M, 3F), Inactin (Δmean ABP= -7±1 mmHg; n=11; 6M, 5F), urethane (Δmean ABP= -19±4 mmHg; n=11; 6M, 5F), and Isoflurane (Δmean ABP= -6±3 mmHg; n=10; 5M, 5F) groups. SNA was differentially altered during renal artery occlusion. Renal SNA significantly increased in the decerebrate (149±24%), Inactin (130±9%), and urethane (144±24%) groups relative to baseline but was significantly reduced in the isoflurane group (79±2%). Splanchnic SNA was similarly increased in decerebrate (130±12%), Inactin (150±23%), and urethane (147±19%) groups yet was significantly reduced in the isoflurane group (79±4%) compared to baseline. In marked contrast, renal artery occlusion decreased lumbar SNA in all groups (Decerebrate: 68±7%; Inactin: 67±5%; urethane: 58±3%; and Isoflurane: 63±7%. In conclusion, anesthesia differentially influences SNA and ABP responses during renal artery occlusion. In the majority of groups, arterial occlusion a differential SNA response characterized by increased renal and splanchnic SNA but decreased lumbar SNA. Isoflurane anesthesia attenuated sympathoexcitation across all groups.

Rare Clinical Cases of Renal Artery Thrombosis

Objective: Renal vascular thrombosis is a thrombotic blockage of the major renal arteries resulting in acute damage or chronic kidney disease. The study aims to analyze rare clinical cases of renal artery thrombosis with following renal infarction.
 Materials and methods: The article present a retrospective study of examination and treatment results of patients diagnosed with the renal arteries thrombosis in the urological hospital of the Irkutsk Clinical Hospital No. 1 in the period 2012-2020.
 Results and Discussion: During the entire observation period, there were two clinical cases of acute renal artery thrombosis. The 86-year-old woman developed thrombosis because of atrial fibrillation, which was probably the result of inadequate correction (insufficient dose of anticoagulant). Kidney infarction had complications like rapid suppuration because of chronic urinary infection and calculus of the renal pelvis. It resulted in nephrectomy with subsequent recovery. The second case was the 45-year-old man examined according to existing standards, and the diagnosed-on time in the first hours of the disease. However, complete thrombosis of the right renal artery neutralized the effectiveness of conservative therapy with warfarin. In this case, nephrosclerosis and renal failure were natural.
 Conclusion: Renal artery thrombosis is a rare pathology that requires special attention from the clinician due to the high risk of renal function loss. Timely diagnosis and correct treatment tactics are especially important.
 Bangladesh Journal of Medical Science Vol.20(3) 2021 p.550-555

Acute renal artery thrombosis associated with the use of an oral contraceptive pill

Peripheral, and even visceral, venous thromboembolism is a known complication of oral contraceptive drugs (OCPs) but arterial disease, leading to renal infarction, is rarely reported. We describe a 36-year-old female patient who presented with sudden left loin pain for 2 days. Ultrasound examination showed a wedge-shaped echogenic lesion at lateral side of the left kidney. Computed tomography with contrast showed the area to be avascular and the arteriogram showed abrupt loss of the dorsal branch of left main renal artery, which lacked any deformities, confirming diagnosis of thrombosis-in-situe. Moreover, the pelvicalyceal system did not show abnormality which ruled out ascending infection. The patient did not have a family history or laboratory evidence of hypercoagulable disorder. An OCP was the only medication she had received in the previous 3 months. The OCP was discontinued, and the patient was treated with heparin for 3 days then Abixaban for 6 months. Subsequent CT study with contrast, 3 months later, showed lateral kidney scar. On follow up; she did not have subsequent thrombotic events up to 1 year. 
 Keywords: Abixaban, infarction, Kidney, oral contraceptive, thrombosis.

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

BackgroundTo evaluate how far is selective renal artery embolization (RAE) using permanent agents effective in treating acute renal artery bleeding. We retrospectively reviewed the medical records of patients (n = 45) with renal bleeding who were managed by selective RAE using coils, N-butyl-cyanoacrylate glue (NBCA glue), and polyvinyl alcohol (PVA). Data retrieved included the cause, number, and type of the bleeding lesions as well as the results of the embolization for 1 year after RAE. Clinical success was the primary outcome while re-bleeding and complications were the secondary outcomes.ResultsThere were 55 bleeding lesions detected by angiography in the included 45 patients. Coils were used in 23/45 patients (51.1%), NBCA glue in 15/45 patients (33.3%), and PVA in 7 patients (15.6%). Bleeding could be controlled with embolization in a single session in 41/45 patients with primary clinical success 91.1%. Four patients needed re-embolization sessions to control bleeding and only one patient was controlled, giving secondary clinical success of 92.3%. Three patients failed to respond to embolization and nephrectomy was done. Iatrogenic dissection of the segmental branch was seen in one patient. Post embolization syndrome was seen in 14/45 patients (31.1%). Non-target embolization was seen in 2 patients: one during treatment with NBCA glue and the other with PVA. No other complications were recorded. No significant differences between clinical success among coil, NBCA glue, and PVA subgroups (P > 0.05).ConclusionSelective RAE using permanent agents is effective in controlling renal bleeding and no significant difference among coil, NBCA glue, and PVA.

Numerical investigation of renal artery hemodynamics based on the physiological response to renal artery stenosis

Renal Artery Stenosis (RAS) is the narrowing of renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. Possible complications of renal artery stenosis are renovascular hypertension and renal ischemia. The goals of the current study were to investigate the physiological response to RAS and effects of the artery and stenosis geometry, quantify the performance of arterial pressure regulation mechanisms respect to stenosis severity, and predict future conditions of renal artery stenosis. Commercial software based on the finite volume method was utilized to solve governing equations. To determine the physiological response, simulations were done for two cases, with and without the involvement of arterial pressure regulation mechanisms. The numerical method was validated by experimental data, which obtained from two prototypes. Results showed that systemic blood pressure was increased as the physiological response to RAS; hence, the flow rate of the renal branch was improved and renal ischemia was relatively prevented. Furthermore, results demonstrated that the stenosis percentage and artery diameter were dominant geometric parameters on the hemodynamics and other parameters had negligible effects. It was demonstrated that 50% of stenosis was the critical point for the interaction of RAS and arterial pressure regulation mechanisms. Finally, wall shear stress was analyzed on an image-based geometry, and it was estimated and expected that acute renal artery stenosis was progressive and pathogenesis of arterial diseases.

Renal artery thrombosis following synthetic cannabinoid ingestion

Cannabis and synthetic cannabinoids have been associated with cardiovascular events including myocardial infarction, arrhythmias, and stroke. The psychoactive cannabinoid delta-9-tetrahydrocannabinol (THC) is a partial agonist for cannabinoid receptors found in the brain, vascular endothelium, liver, and adipose tissue. THC has been implicated in cases of cannabis arteritis and vasculopathy. We describe a case of acute renal artery infarction following synthetic cannabinoid ingestion, with successful thrombolysis and revascularization.

SARCOIDOSIS ASSOCIATED GRANULOMATOUS VASCULITIS CAUSING HYPERTENSION AND ACUTE RENAL INFRACTION IN A TEENAGE BOY

Atherosclerosis, fibromuscular dysplasia and arteritis are the common etiology for renovascular stenosis associated secondary hypertension. A, 14 year old, Chinese boy admitted to hospital because of hypertension. He was diagnosed with acute renal infraction and renal artery stenosis (Figure 1A, B