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Spontaneous renal artery dissection with renal infarction.

Renaud S, Leray-Moragu├Ęs H, Chenine L, Canaud L, Vernhet-Kovacsik H, Canaud B - Clin Kidney J (2012)

Bottom Line: We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD.Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment.We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.

View Article: PubMed Central - PubMed

Affiliation: Physiology Department, George Pompidou European Hospital, APHP, Paris, France.

ABSTRACT
Spontaneous renal artery dissection (SRAD) is a rare entity, which often presents diagnostic difficulties because of its non-specific clinical presentation. We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD. Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment. We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.

No MeSH data available.


Related in: MedlinePlus

Enhanced abominal CTS showing median infarction of the left kidney (patient number six).
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fig1: Enhanced abominal CTS showing median infarction of the left kidney (patient number six).

Mentions: In this study, we report six patients who were referred to our nephrology department between 1997 and 2010 and presented with SRAD. All were men between 33 and 55 years of age. They had no cardiovascular risk factors, except one patient who had a past history of smoking. All patients presented acute unilateral flank pain with inguinal irradiation and sometimes haematuria on urinary dipstick testing and were most commonly diagnosed with renal colic, delaying the diagnosis of renal infarction by several days (Table 1). Most were hypertensive but only two patients had acute renal failure. Proteinuria was significant in two cases. Among the most frequent biochemical abnormalities, we noted elevated lactate dehydrogenase concentrations and inflammatory markers including increased white blood cells, C-reactive protein and fibrinogen levels (Table 2). Haemostasis was within the normal range, but the research for circulating anticoagulant was positive in two patients (data not shown). Renal ultrasound was performed in all cases at admission but failed to detect renal infarction. We performed contrast-enhanced abdominal CTS to diagnose the renal infarction (Figure 1) and estimate the area of extension (between 15 and 50% of the kidney surface). Renal infarction affected mainly the left side (4/6) but was bilateral in one patient. We then performed angiotomodensitometry (A-CTS) in some cases and magnetic resonance imaging angiography (A-MRI) in others, completed by percutaneous selective renal arteriography (Figure 2) to identify vascular lesions and the vessels' anatomy. Three patients had multiple renal arteries and the dissection usually affected segmental branches but concerned also the main renal artery in two cases. Signs of arterial fibrodysplasia were detected in four patients. Only one of them was treated by angioplasty with stent implantation (two stents), whilst conservative management was elected for all other patients for various reasons including the presence of a circulating false lumen, overpassed renal infarction or dissection of small branches of arteries, precluding revascularization possibilities. All patients were treated by oral anticoagulation (anti-vitamin K) or anti-platelets. Two patients were lost to follow-up; the others were followed up for a period of between 4 months and 13 years. They had normal blood pressure (one without any treatment and three with anti-hypertensive drug therapy) and their renal function remained stable.


Spontaneous renal artery dissection with renal infarction.

Renaud S, Leray-Moragu├Ęs H, Chenine L, Canaud L, Vernhet-Kovacsik H, Canaud B - Clin Kidney J (2012)

Enhanced abominal CTS showing median infarction of the left kidney (patient number six).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400519&req=5

fig1: Enhanced abominal CTS showing median infarction of the left kidney (patient number six).
Mentions: In this study, we report six patients who were referred to our nephrology department between 1997 and 2010 and presented with SRAD. All were men between 33 and 55 years of age. They had no cardiovascular risk factors, except one patient who had a past history of smoking. All patients presented acute unilateral flank pain with inguinal irradiation and sometimes haematuria on urinary dipstick testing and were most commonly diagnosed with renal colic, delaying the diagnosis of renal infarction by several days (Table 1). Most were hypertensive but only two patients had acute renal failure. Proteinuria was significant in two cases. Among the most frequent biochemical abnormalities, we noted elevated lactate dehydrogenase concentrations and inflammatory markers including increased white blood cells, C-reactive protein and fibrinogen levels (Table 2). Haemostasis was within the normal range, but the research for circulating anticoagulant was positive in two patients (data not shown). Renal ultrasound was performed in all cases at admission but failed to detect renal infarction. We performed contrast-enhanced abdominal CTS to diagnose the renal infarction (Figure 1) and estimate the area of extension (between 15 and 50% of the kidney surface). Renal infarction affected mainly the left side (4/6) but was bilateral in one patient. We then performed angiotomodensitometry (A-CTS) in some cases and magnetic resonance imaging angiography (A-MRI) in others, completed by percutaneous selective renal arteriography (Figure 2) to identify vascular lesions and the vessels' anatomy. Three patients had multiple renal arteries and the dissection usually affected segmental branches but concerned also the main renal artery in two cases. Signs of arterial fibrodysplasia were detected in four patients. Only one of them was treated by angioplasty with stent implantation (two stents), whilst conservative management was elected for all other patients for various reasons including the presence of a circulating false lumen, overpassed renal infarction or dissection of small branches of arteries, precluding revascularization possibilities. All patients were treated by oral anticoagulation (anti-vitamin K) or anti-platelets. Two patients were lost to follow-up; the others were followed up for a period of between 4 months and 13 years. They had normal blood pressure (one without any treatment and three with anti-hypertensive drug therapy) and their renal function remained stable.

Bottom Line: We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD.Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment.We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.

View Article: PubMed Central - PubMed

Affiliation: Physiology Department, George Pompidou European Hospital, APHP, Paris, France.

ABSTRACT
Spontaneous renal artery dissection (SRAD) is a rare entity, which often presents diagnostic difficulties because of its non-specific clinical presentation. We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD. Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment. We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.

No MeSH data available.


Related in: MedlinePlus