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End stage renal disease caused by thromboangiitis obliterans: a case report.

Yun HJ, Kim DI, Lee KH, Lim SJ, Hwang WM, Yun SR, Yoon SH - J Med Case Rep (2015)

Bottom Line: He also had abdominal angina.Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.But once it occurs, it can be life-threatening.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. yhj0927@kyuh.ac.kr.

ABSTRACT

Introduction: Thromboangiitis obliterans or Buerger's disease is a nonatherosclerotic, segmental, inflammatory vasculitis that is strongly associated with tobacco products and commonly affects the small- and medium-sized arteries of the upper and lower extremities. However, the disease can, rarely, involve large central or visceral arteries. We report here the case of end stage renal disease due to renal artery thrombosis caused by thromboangiitis obliterans.

Case presentation: A 51-year-old Korean man who had previously required amputation of both great toes due to thromboangiitis obliterans presented with left flank pain and oliguria. Both his renal arteries were occluded on contrast-enhanced abdominal computed tomography and abdominal angiography. He also had abdominal angina. He had no risk factor of thromboembolism from cardiac origin, atherosclerosis except for tobacco abuse, collagen diseases or hypercoagulable disorders. Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.

Conclusions: Renal failure due to renal artery thrombosis and mesenteric ischemia represents an unusual manifestation of thromboangiitis obliterans. But once it occurs, it can be life-threatening. When we care for a patient with thromboangiitis obliterans, we should pay attention to this rare disease course, and encourage cessation of the smoking of tobacco products.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced abdominal CT and abdominal aorta CT angiography. Contrast-enhanced abdominal CT demonstrated colitis of the (a) hepatic flexure and (b) transverse colon, most likely due to ischemic colitis. c Abdominal aorta CT angiography showed total occlusion of both renal arteries (white arrows). Superior and inferior mesenteric arteries cannot be seen because the arteries were occluded from their origins
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Fig4: Contrast-enhanced abdominal CT and abdominal aorta CT angiography. Contrast-enhanced abdominal CT demonstrated colitis of the (a) hepatic flexure and (b) transverse colon, most likely due to ischemic colitis. c Abdominal aorta CT angiography showed total occlusion of both renal arteries (white arrows). Superior and inferior mesenteric arteries cannot be seen because the arteries were occluded from their origins

Mentions: Renal failure associated with TAO progression was diagnosed. He started continuous ambulatory peritoneal dialysis (CAPD) and stopped smoking tobacco products. He was discharged with a daily oral anticoagulant, warfarin. Two months after discharge, he complained of postprandial abdominal pain without muscle guarding, preventing him from eating and resulting in an approximately 10kg weight loss. Upper gastrointestinal endoscopy revealed gastric mucosal atrophy; a follow-up contrast-enhanced abdominal CT showed colitis of the hepatic flexure and transverse colon, which was consistent with ischemic colitis. His vessel status had not changed compared with that at the prior examination (Fig. 4). He changed his dialysis modality from CAPD to hemodialysis, which improved his pain. He recently reported abdominal pain with hypotension; however, after a decrease in his hypertension medications and an increase in body weight, his pain resolved.Fig. 4


End stage renal disease caused by thromboangiitis obliterans: a case report.

Yun HJ, Kim DI, Lee KH, Lim SJ, Hwang WM, Yun SR, Yoon SH - J Med Case Rep (2015)

Contrast-enhanced abdominal CT and abdominal aorta CT angiography. Contrast-enhanced abdominal CT demonstrated colitis of the (a) hepatic flexure and (b) transverse colon, most likely due to ischemic colitis. c Abdominal aorta CT angiography showed total occlusion of both renal arteries (white arrows). Superior and inferior mesenteric arteries cannot be seen because the arteries were occluded from their origins
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
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getmorefigures.php?uid=PMC4541743&req=5

Fig4: Contrast-enhanced abdominal CT and abdominal aorta CT angiography. Contrast-enhanced abdominal CT demonstrated colitis of the (a) hepatic flexure and (b) transverse colon, most likely due to ischemic colitis. c Abdominal aorta CT angiography showed total occlusion of both renal arteries (white arrows). Superior and inferior mesenteric arteries cannot be seen because the arteries were occluded from their origins
Mentions: Renal failure associated with TAO progression was diagnosed. He started continuous ambulatory peritoneal dialysis (CAPD) and stopped smoking tobacco products. He was discharged with a daily oral anticoagulant, warfarin. Two months after discharge, he complained of postprandial abdominal pain without muscle guarding, preventing him from eating and resulting in an approximately 10kg weight loss. Upper gastrointestinal endoscopy revealed gastric mucosal atrophy; a follow-up contrast-enhanced abdominal CT showed colitis of the hepatic flexure and transverse colon, which was consistent with ischemic colitis. His vessel status had not changed compared with that at the prior examination (Fig. 4). He changed his dialysis modality from CAPD to hemodialysis, which improved his pain. He recently reported abdominal pain with hypotension; however, after a decrease in his hypertension medications and an increase in body weight, his pain resolved.Fig. 4

Bottom Line: He also had abdominal angina.Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.But once it occurs, it can be life-threatening.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. yhj0927@kyuh.ac.kr.

ABSTRACT

Introduction: Thromboangiitis obliterans or Buerger's disease is a nonatherosclerotic, segmental, inflammatory vasculitis that is strongly associated with tobacco products and commonly affects the small- and medium-sized arteries of the upper and lower extremities. However, the disease can, rarely, involve large central or visceral arteries. We report here the case of end stage renal disease due to renal artery thrombosis caused by thromboangiitis obliterans.

Case presentation: A 51-year-old Korean man who had previously required amputation of both great toes due to thromboangiitis obliterans presented with left flank pain and oliguria. Both his renal arteries were occluded on contrast-enhanced abdominal computed tomography and abdominal angiography. He also had abdominal angina. He had no risk factor of thromboembolism from cardiac origin, atherosclerosis except for tobacco abuse, collagen diseases or hypercoagulable disorders. Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.

Conclusions: Renal failure due to renal artery thrombosis and mesenteric ischemia represents an unusual manifestation of thromboangiitis obliterans. But once it occurs, it can be life-threatening. When we care for a patient with thromboangiitis obliterans, we should pay attention to this rare disease course, and encourage cessation of the smoking of tobacco products.

No MeSH data available.


Related in: MedlinePlus