Renal artery occlusion (acute)
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.
- thromboembolism (e.g. atrial fibrillation, myocardial infarction, atrial myxoma, plaque rupture, bacterial endocarditis, etc.)
- aortic dissection
- iatrogenic (e.g. endovascular intervention such as EVAR)
- hypercoagulable disorders
- sickle cell disease 3
- cocaine abuse
- congenital vascular disorders
- fibromuscular dysplasia
- transplant sepsis 3
Fluoroscopy - IVP
- 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 oedematous kidney with perinephric stranding 2
- patchy enhancement or non-enhancing kidney +/- 'cortical rim sign'
- wedge-shaped focal infarcts if a segmental artery occlusion
Angiography (CT and conventional)
CT angiography shows the hypodense thrombus within the lumen, with possible attenuation of distal branches.
Treatment and prognosis
Acute renal artery occlusion is an emergency and requires immediate intervention. Treatment modalities include anticoagulation and thrombolysis/thrombectomy with renal artery stenting 1,3.
- 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
- 4. Lopera JE, Suri R, Kroma G et-al. Traumatic occlusion and dissection of the main renal artery: endovascular treatment. J Vasc Interv Radiol. 2011;22 (11): 1570-4. doi:10.1016/j.jvir.2011.08.002 - Pubmed citation