Renal artery occlusion can happen acutely due to in-situ thrombus, embolism, or dissection. Unless immediately treated, it can lead to renal infarction 1.
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Epidemiology
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.
Risk factors
thromboembolism (e.g. atrial fibrillation, myocardial infarction, atrial myxoma, plaque rupture, bacterial endocarditis, etc.)
iatrogenic (e.g. endovascular intervention such as EVAR)
hypercoagulable disorders
cocaine abuse
congenital vascular disorders
transplant sepsis 3
Clinical presentation
Acute pain in the ipsilateral flank, lower abdomen or back are the usual presenting symptoms.
Radiographic features
Fluoroscopy - IVP
after contrast administration there may be faint opacification (or non-opacification) of the affected kidney (with 'rim nephrogram' sign)
the affected kidney may be normal or enlarged
CT
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
Angiography (CT/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.
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