Acute renal arterial occlusion

An acute renal arterial occlusion is a rare clinical condition which can happen due to in-situ thrombus or embolism. Unless immediately treated, it can lead to renal infarction¹.

Epidemiology

Condition is common in elderly age group, however may be seen in younger age group with risk factors (described below). 10% of the cases have bilateral involvement.

Clinical features

Acute pain in flank, lower abdomen or back can be the usual presenting symptom.

Pathology

Aetiological factors

• thromboembolism (e.g. atrial fibrillation, myocardial infarction, atrial myxoma, plaque rupture, bacterial endocarditis etc.)
• trauma
• congenital vascular disorders
• fibromuscular dysplasia
• hypercoagulable disorders
• aortic dissection
• iatrogenic (endovascular intervention)
• transplant sepsis ³
• sickle cell disease ³
• cocaine abuse

Radiographic features

Fluoroscopy - IVP

May show a normal or enlarged kidney with faint/non-opacification of involved kidney (with 'rim nephrogram' sign).

CT

• acutely swollen and edematous kidney with perinephric streakiness ².
• patchy enhancement / non-enhancing kidney + / - 'cortical rim sign'. 
• wedge shaped focal infarcts may also been in segmental artery occlusion.

Angiography (CT and conventional)

CT Angiography shows the hypodense thrombus withing the lumen, with attenuation of distal branches.

Treatment and prognosis

Acute renal artery occlusion is an emergency and requires immediate intervention. Treatment modalities are anticoagulation, thrombolysis/thrombectomy with renal artery stenting^1,3. Immediate revascularization is achieved after taking these measures (see case 1).

See also

• renal infarct
• renal cortical necrosis