Intraparenchymal Renal Artery Research Articles

Эндоваскулярное лечение больного с гигантской интраренальной аневризмой почечной артерии (клиническое наблюдение)

Эндоваскулярное лечение больного с гигантской интраренальной аневризмой почечной артерии (клиническое наблюдение)

Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature.We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts.He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization.This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

A case of retroperitoneal hematoma and hemorrhagic shock caused by spontaneous intraparenchymal renal artery aneurysm rupture

article: A case of retroperitoneal hematoma and hemorrhagic shock caused by spontaneous intraparenchymal renal artery aneurysm rupture - Italian Journal of Emergency Medicine 2021 December;10(3):165-7 - Minerva Medica - Journals

CT Imaging of Renovascular Abnormalities

Abnormalities of the renal vasculature can manifest clinically as renal ischemia, renal insufficiency, and secondary hypertension. It is crucial to inspect the renal vessels not only for intrinsic or direct causes of vascular disease, but also for the enhancement pattern of the renal parenchyma as an indirect sign for vascular compromise. Although atherosclerotic renal artery stenosis is the most common renal vascular disease, fibromuscular dysplasia of the renal artery is the second most common and has characteristic imaging findings. Some vasculitides may affect the renal artery, and these need to be considered when there is abnormal soft tissue surrounding the artery or the kidney has a striated nephrogram. Arteriovenous abnormalities are divided into arteriovenous fistulas and arteriovenous malformations. A prominent renal artery in communication with a renal vein or a tangle of vessels associated with a prominent and early filling renal vein is very suggestive of a renal arteriovenous abnormality. Intraparenchymal renal artery aneurysms are not as common as main renal artery aneurysms, but the former can mimic a tumor, and a high index of suspicion is required to make the correct diagnosis. Many of these pathologies, in addition to renal trauma, can result in reduced perfusion or infarction of part of or all of the kidney.

Intra-Parenchymal Renal artery aneurysm in a young pregnant patient

Introduction: Renal artery aneurysms are rare clinical entities with an estimated incidence of less than 1% with 10% of these aneurysms being associated with intraparenchymal aneurysms of the renal artery. The presentation of these aneurysms is highly variable. The consequences of missing the diagnosis can be catastrophic. Pregnancy increases the risk of rupture with these aneurysms and presents a dilemma for the managing physician. There are several methods of managing a renal artery aneurysm although no established guidelines exist. Surgical approaches range from endovascular techniques to open procedures such as ex-vivo aneurysmal repair with auto-transplantation, with a partial or total nephrectomy being reserved as techniques of last resort. Case Report: We present a case of a 36-year-old primigravid female with a left renal artery aneurysm unsuitable for endovascular therapy. Attempt was made for laparoscopic donar nephrectomy, ex-vivo aneurysm repair with auto transplantation; however laparoscopic left nephrectomy was performed because of the intraparenchymal location of the aneurysm. Conclusion: Renal artery aneurysms should always be considered as a differential in patients with secondary hypertension. Close follow up is required if detected in pregnant patients as these increased the risk of fatal outcomes. Attempt should be taken to preserve the kidney function. A multi-disciplinary approach is required to decrease morbidity and mortality in these patients. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 6 No. 12, December 2015. ISSN – [0976-3198] Int J Case Rep Images 2015;6(12):747–751. www.ijcasereportsandimages.com Islam et al. 747 CASE REPORT OPEN ACCESS Intra-parenchymal renal artery aneurysm in a young pregnant patient Shariful Islam, Devin Hosein, Dave Harnanan, Dilip Dan

Glued angiocatheter: a rare complication of intrarenal pseudoaneurysm glue angioembolization.

Endovascular management of intraparenchymal renal artery pseudoaneurysms is a reasonable and effective therapeutic technique. Endovascular management preserves the maximum amount of renal tissue and reduces the potential risk of nephrectomy. We present the case of an angiocatheter that became stuck in the renal artery following the injection of cyanoacrylate glue for angioembolization of an intrarenal pseudoaneurysm.

Transarterial treatment of congenital renal arteriovenous fistulas

Congenital renal arteriovenous fistulas (CRAVF) represent a distinct clinical entity with characteristic hemodynamic and angiographic features. Treatment is warranted given potential for growth with renal and hemodynamic compromise. We report our experience in a rare series of treated symptomatic CRAVFs. Over a 10-year period, patients treated for symptomatic CRAVFs (no history of predisposing renal pathology, instrumentation, neoplasm, or trauma) were retrospectively investigated for clinical presentation, imaging features, treatment outcomes, and complications. Technical success included delivery of embolic agent with complete obliteration of fistula. Clinical success included resolution of symptoms and freedom from recurrence and/or reintervention. Renal parenchymal loss was estimated by postembolization angiography and categorized as 0%, <25%, 25%-50%, or >50%. Twenty-five patients were referred with a presumptive diagnosis of intraparenchymal renal artery aneurysms. Of these, 10 had true intrarenal aneurysms, three had angiomyolipomas, and 12 had CRAVFs (mean age, 54; range, 29-71 years; eight women). Presenting symptoms included hematuria (eight gross, eight microscopic), refractory hypertension (diastolic blood pressure ≥ 90 mm Hg despite three or more medications; n = 6), flank pain (n = 8), high-output state (HOS; featuring tachycardia and jugular venous distention; n = 3), and flank bruit (n = 1). Defining angiographic features included a high-flow AVF fed by a single, enlarged intrarenal branch shunting into an aneurismal draining vein, occasionally featuring a calcified rim (four patients). All patients underwent transarterial embolization with coils (n = 5), coils and n-butylcyanoacrylate (n = 3), detachable balloons (n = 2), or Amplatzer plugs (n = 2). Technical success was 100%. Hematuria, tachycardia, jugular venous distension, pain, and bruit resolved in all. Hypertension improved in four of six patients (required less than three medications postembolization). Complications included postembolization syndrome in nine patients. Parenchymal loss was limited to <25% and observed in five patients without development of acute kidney injury or worsening hypertension. There were no recurrences or reinterventions at a mean follow-up of 55 months (range, 5-96 months). There was one death at 8 years follow-up from intercurrent coronary disease in a patient without high-output state. With greater awareness and accurate diagnosis, effective and durable transarterial treatment of CRAVFs can be safely performed.

A Cough Deteriorating Gross Hematuria: A Clinical Sign of a Forthcoming Life-Threatening Rupture of an Intraparenchymal Aneurysm of Renal Artery (Wunderlich's Syndrome)

Macroscopic hematuria regards the 4% to 20% of all urological visits. Renal artery aneurysms (RAAs) are detected in approximately 0.01%–1% of the general population, while intraparenchymal renal artery aneurysms (IPRAAs) are even more rarely detected in less than 10% of patients with RAAs. We present a case of a 58-year-old woman that came into the emergency room (ER) complaining of a gross hematuria during the last four days. Although in the ER room the first urine sample was clear after a cough episode, a severe gross hematuria began which led to a hemodynamically unstable patient. Finally, a radical nephrectomy was performed, and an IPRAA was the final diagnosis. A cough deteriorating hematuria could be attributed to a ruptured intraparenchymal renal artery aneurysm, which even though constitutes a rare entity, it is a life-threatening medical emergency.

Bilateral Spontaneous Perirenal Hemorrhage in an Acquired Cystic Kidney Disease Hemodialysis Patient

Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics.

Unusual presentation of intraparenchymal renal artery aneurysm mimicking cystic renal cell carcinoma: A case report

We describe a case of intraparenchymal renal artery aneurysm in a 58-year-old normotensive man with a history of distal ureterectomy. Imaging studies of the pre-existing right renal mass had been interpreted as being consistent with a simple renal cyst. Three years after ureterectomy, a small parietal nodule with contrast enhancement developed within the cyst. Partial nephrectomy was carried out based on a preoperative diagnosis of cystic kidney cancer. Surprisingly, pathological diagnosis was an aneurysm with a revascularized thrombus. Even though the present case represents an extremely rare clinical manifestation of intraparenchymal renal artery aneurysm, clinicians should be aware that imaging studies cannot distinguish all instances of renal vascular disease.

Successful management of renal artery aneurysm rupture after cesarean section

Renal artery aneurysm is a rare entity, and patients are usually asymptomatic at the time of presentation. These aneurysms are rare among pregnant patients, especially after childbirth, and usually form due to changes in vascular wall integrity secondary to hormonal and hemodynamic changes. Here we describe a patient with an intraparenchymal renal artery aneurysm that ruptured after a cesarean section but was immediately identified and managed appropriately, allowing for a successful outcome.

Vascular Structure and Oxidative Stress in Salt-Loaded Spontaneously Hypertensive Rats: Effects of Losartan and Atenolol

Renin-angiotensin system (RAS) modulation by high dietary sodium may contribute to salt-induced hypertension, oxidative stress, and target organ damage. We investigated whether angiotensin II (Ang-II) type 1 (AT1)-receptor blockade (losartan) could protect the aorta and renal arteries from combined hypertension- and high dietary salt-related oxidative stress. Spontaneously hypertensive rats (3-month-old, n = 10/group) received tap water (SHR), water containing 1.5% NaCl (SHR+S), 1.5% NaCl and 30 mg losartan/kg/day (SHR+S+L), or 50 mg atenolol/kg/day (SHR+S+A). Atenolol was used for comparison. Ten Wistar-Kyoto rats (WKY) were controls. Systolic blood pressure (SBP) was determined by tail plethysmography. After 5 months of treatment, vascular remodeling and oxidative stress (superoxide production and NAD(P)H-oxidase activity (chemiluminescence), malondialdehyde (MDA) content (high-performance liquid chromatography), endothelial nitric oxide synthase (eNOS) activity [(14)C-arginine to (14)C citrulline], CuZn-SOD activity (spectrophotometry)) were studied. In SHR, salt-loading significantly aggravated hypertension, urinary protein excretion, intraparenchymal renal artery (IPRArt) perivascular fibrosis, aortic and renal artery oxidative stress, and induced endothelial cell loss in IPRArts. In salt-loaded SHR, 5-month losartan and atenolol treatments similarly reduced SBP, but only losartan significantly prevented (i) urinary protein excretion increase, (ii) or attenuated hypertension-related vascular remodeling, (iii) aortic MDA accumulation, (iv) renal artery eNOS activity lowering, and (v) aortic and renal artery superoxide dismutase (SOD) activity reduction. In SHR+S, the contributions to aortic superoxide production were as follows: uncoupled eNOS > xanthine oxidase (XO) > NAD(P)H oxidase. In this salt-sensitive genetic hypertension model, losartan protects from hypertension- and high dietary salt-related vascular oxidative stress, exceeding the benefits of BP reduction. Also, during salt overload, BP-independent factors contribute to vascular remodeling, at least part of which derive from AT1-receptor activation.

Hématurie macroscopique révélatrice d’un anévrisme des artères intrarénales

Intraparenchymal renal artery aneurysms in the renal artery are rare in the general population. Prevalence range from 0.01 to 1.0%, women are more often affected and the predominant location is the right kidney. Several complication have been described, hypertension, dissection, thrombosis, renal infarction and spontaneous rupture. Here, we report a case of an aneurysm of a branch of the left renal artery diagnosed after gross haematuria. Selective intra-arterial embolization leads to the thrombosis of the aneurysm and the disappearance of haematuria.

A Case of Shock Due to a Ruptured Intraparenchymal Renal Artery Aneurysm

A Case of Shock Due to a Ruptured Intraparenchymal Renal Artery Aneurysm

Intraparenchymal renal artery aneurysms. Case report with review and update of the literature

Increased interest in aneurysms involving the renal artery and its branches has occurred during the past 3 decades. The prevalence of renal artery aneurysms is approximately 0.01%-1% in the general population as well as 2.5% in hypertensive patients undergoing angiography. Intraparenchymal renal artery aneurysms (IPRAAs) are rare since being detected in less than 10% of patients with renal artery aneurysms. The Authors report an unusual case of multiple small intrarenal artery aneurysms associated with a large IPRAA located in the mid portion of the right kidney. Usually, IPRAAs are secondary to diseases or injuries of the kidney vascular network. They are classified as true, false, saccular, fusiform, dissecting, and microaneurysms. Potential complications of IPRAAs include peripheral dissection, thrombosis, hypertension, renal infarction and rupture. IRAAs may be detected incidentally as well as present with urologic symptoms and signs related to complications. Actually, IRAAs are investigated by non invasive modalities including duplex ultrasound, magnetic resonance angiography, spiral three-dimensional computed tomography angiography, and three-dimensional reconstructed rotational digital substraction angiography of the segmental and distant branches of the renal artery. Angiography with intrarterial injection of contrast material is the gold standard in diagnosing IPRAAs. Treatment options for IPRAAs include observation, aneurysmectomy with surgical repair, endovascular procedures, nephrectomy or partial nephrectomy. Observation is indicated for asymptomatic intraparenchymal renal artery aneurysms measuring less than 2 cm in diameter. Surgical repair of IPRAAs includes aneurysmectomy and reconstruction of the renal artery by in vivo or ex vivo technique. The procedure is indicated for IPRAAs causing renovascular hypertension, dissection, urologic symptoms, embolization, local expansion and women of childbearing age with a potential for pregnancy. In recent years, transcatheter arterial embolization has emerged as a simple, useful and effective technique in managing IRAAs. The procedure is performed by transfemoral catheterization as well as by superselective catheterization and embolization of interlobar arteries with 3F microcatheters. Endovascular occlusion is obtained by using gelatin sponge, steel coils, detachable baloons, and conventional non-detachable microcoils delivered through a microcatheter. Nephrectomy or partial nephrectomy are reserved for conditions precluding renal revascularization which include overt RAA rupture, covert RAA rupture, artery-to-vein fistula, renal cell carcinoma, end stage nephropaty, renal infarction, severe ischemic renal atrophy or complex intrarenal aneurysms. Recently, partial nephrectomy by the laparoscopic approach has been proposed for managing IPRAAs and the procedure is considered feasible and safe.