Renal artery occlusion (acute)

Last revised by Rohit Sharma on 21 Jan 2023

Renal artery occlusion can happen acutely due to in-situ thrombus, embolism, or dissection. Unless immediately treated, it can lead to renal infarction 1.

The condition is more common in the elderly, however, it may be seen in a younger age group if they have risk factors (described below). 10% of the cases have bilateral involvement.

Acute pain in the ipsilateral flank, lower abdomen or back are the usual presenting symptoms.

  • after contrast administration there may be faint opacification (or nonopacification) of the affected kidney (with 'rim nephrogram' sign)
  • the affected kidney may be normal or enlarged
  • acutely swollen and edematous kidney with perinephric stranding 2
  • patchy enhancement or non-enhancing kidney +/- 'cortical rim sign'
  • wedge-shaped focal infarcts if a segmental artery occlusion

CT angiography shows the hypodense thrombus within the lumen, with possible attenuation of distal branches.

Acute renal artery occlusion is an emergency and requires immediate intervention. Treatment modalities include anticoagulation and thrombolysis/thrombectomy with renal artery stenting 1,3.

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