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.
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.
Acute pain in flank, lower abdomen or back can be the usual presenting symptom.
- thromboembolism (e.g. atrial fibrillation, myocardial infarction, atrial myxoma, plaque rupture, bacterial endocarditis etc.)
- congenital vascular disorders
- fibromuscular dysplasia
- hypercoagulable disorders
- aortic dissection
- iatrogenic (endovascular intervention)
- transplant sepsis 3
- sickle cell disease 3
- cocaine abuse
Fluoroscopy - IVP
May show a normal or enlarged kidney with faint/non-opacification of involved kidney (with 'rim nephrogram' sign).
- 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 stenting1,3. Immediate revascularization is achieved after taking these measures (see case 1).
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- 1. Arabi M, Vellody R, Cho K. Acute Renal Artery Occlusion with Prolonged Renal Ischemia: A Case of Successful Treatment with Stent Placement and Catheter-directed Thrombolysis. J Clin Imaging Sci. 2011;1 : 11. doi:10.4103/2156-7514.76689 - Free text at pubmed - Pubmed citation
- 2. Amilineni V, Lackner DF, Morse WS et-al. Contrast-enhanced CT for acute flank pain caused by acute renal artery occlusion. AJR Am J Roentgenol. 2000;174 (1): 105-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Lopez VM, Glauser J. A case of renal artery thrombosis with renal infarction. J Emerg Trauma Shock. 2010;3 (3): 302. doi:10.4103/0974-2700.66569 - Free text at pubmed - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Renal artery thrombosis||✗|
|Acute renal artery occlusion||✗|