Abstract: SA-PO268
Spontaneous Renal Artery Dissection: A Diagnostic and Therapeutic Challenge
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1403 Hypertension and CVD: Mechanisms
Authors
- Chamarthi, Gajapathiraju, University of Florida Gainesville, Gainesville, Florida, United States
- Koratala, Abhilash, University of Florida Gainesville, Gainesville, Florida, United States
- Lee Loy, Justin, University of Florida Gainesville, Gainesville, Florida, United States
- Ruchi, Rupam, University of Florida Gainesville, Gainesville, Florida, United States
Introduction
Spontaneous renal artery dissection (SRD) is a rare and under-recognized entity and is distinct from traumatic or iatrogenic causes of renal artery dissection. Herein, we present a case of SRD that mimicked a urinary tract infection (UTI).
Case Description
A 44-year-old woman presented to our institution for worsening right flank pain associated with fever and chills. 5 days prior to presentation, she was empirically treated at a local facility for UTI with an oral antibiotic, which failed to relieve her symptoms.Laboratory data was significant for neutrophil-predominant leukocytosis and elevated lactate dehydrogenase. Because of the persistent flank pain, a CTA of the abdomen was obtained which showed right renal infarct and irregularity of the lumen of the renal artery, concerning for focal dissection.Vasculitis work up was negative. Angiogram demonstrated proximal dissection with distal aneurysmal dilatation affecting the superior segmental branch of the right renal artery. Several branches arising from the abnormal vessel appeared to perfuse viable renal parenchyma, mostly within the superior pole and embolization was not performed due to the risk of infarcting such a large volume of tissue, possibly leading to abscess formation. The patient was treated conservatively with medical management for pain and hypertension and was discharged in a stable condition.
Discussion
SRD is most commonly encountered in middle aged men and has been associated with malignant hypertension, fibromuscular dysplasia, collagen vascular diseases, cocaine use and extracorporeal shock wave lithotripsy in the literature. The symptoms can be nonspecific and often mimic other conditions such as pyelonephritis and nephrolithiasis. Conservative management includes hypertension and pain control with or without systemic anticoagulation. Endovascular interventions and surgical revascularization are reserved for patients with hemodynamically significant occlusions of the arteries, uncontrolled renovascular hypertension and worsening renal function or progression of dissection.