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Aoki Y, Sakai Y, Kimura T, Yamaoka T, Maekawa S, Maekawa J, Sano M, Matsuno K, Ishibashi I. Renal Artery Stenting Recovered Renal Function after Spontaneous Renal Artery Dissection. Intern Med 2019; 58:2191-2194. [PMID: 30996183 PMCID: PMC6709337 DOI: 10.2169/internalmedicine.2550-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Spontaneous renal artery dissection (SRAD) is a rare entity and the management of this disease has not been established. A 54-year-old man presented with severe flank pain, and contrast-enhanced computed tomography images suggested SRAD in his left renal artery. After two weeks of conservative treatment, stents were placed in the renal artery. The pre- and post-procedural renal function was independently assessed by renography. After stenting, his left renal function recovered from the renal failure pattern. Renal artery stenting in an acute phase of SRAD may salvage the renal function, even if it appears to be non-functioning.
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Affiliation(s)
- Yasuhiro Aoki
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Yoshiaki Sakai
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Takashi Kimura
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Tomoki Yamaoka
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Sachiko Maekawa
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Junpei Maekawa
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Masanori Sano
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Koki Matsuno
- Department of Cardiology, Chiba Emergency Medical Center, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Japan
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Gun C, Aldinc H, Yaylaci S, Gudelci T, Karcioglu O. What do we miss without contrast in patients with flank pain? Am J Emerg Med 2016; 34:765.e3-5. [PMID: 26439094 DOI: 10.1016/j.ajem.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022] Open
Abstract
Flank pain is a common complaint in the emergency department, and the most frequent cause of flank pain is urolithiasis. Spontaneous renal artery dissection and renal artery thrombosis are rare causes of abdominal pain which can result in renal parenchymal injury. They are mostly difficult to diagnose and treat in the emergency setting. The present report describes 2 patients admitted to the emergency department because of acute flank pain who were diagnosed with renal infarction.
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Affiliation(s)
- Cem Gun
- Department of Emergency Medicine, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Hasan Aldinc
- Department of Emergency Medicine, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Serpil Yaylaci
- Department of Emergency Medicine, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Tansu Gudelci
- Department of Urology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Ozgur Karcioglu
- Department of Emergency Medicine, Acıbadem University School of Medicine, Istanbul, Turkey
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Isolated Spontaneous Renal Artery Dissection Presented with Flank Pain. Case Rep Radiol 2015; 2015:896706. [PMID: 26090259 PMCID: PMC4452194 DOI: 10.1155/2015/896706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/03/2015] [Indexed: 10/24/2022] Open
Abstract
Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction.
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Renaud S, Leray-Moraguès H, Chenine L, Canaud L, Vernhet-Kovacsik H, Canaud B. Spontaneous renal artery dissection with renal infarction. Clin Kidney J 2015; 5:261-4. [PMID: 26069781 PMCID: PMC4400519 DOI: 10.1093/ckj/sfs047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/30/2012] [Indexed: 12/03/2022] Open
Abstract
Spontaneous renal artery dissection (SRAD) is a rare entity, which often presents diagnostic difficulties because of its non-specific clinical presentation. We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD. Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment. We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.
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Affiliation(s)
- Sophie Renaud
- Physiology Department, George Pompidou European Hospital, APHP, Paris, France
| | - Hélène Leray-Moraguès
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Leila Chenine
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Vascular and Radiology Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Bernard Canaud
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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Afshinnia F, Sundaram B, Rao P, Stanley J, Bitzer M. Evaluation of characteristics, associations and clinical course of isolated spontaneous renal artery dissection. Nephrol Dial Transplant 2013; 28:2089-98. [PMID: 23563282 DOI: 10.1093/ndt/gft073] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spontaneous renal artery dissection (SRAD) is a rare entity of unknown etiology. We aimed to study the clinical course and outcomes and compare the characteristics of patients with SRAD with those of the general population. METHODS All cases of isolated renal artery dissection diagnosed at the University of Michigan Hospitals between January 2000 and July 2012 were identified by the ICD-9 code. Cases were matched by age, gender and race with individuals from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Characteristics and awareness of comorbid conditions were compared. Information about the clinical course after diagnosis was retrieved from the case group to ascertain their outcomes. RESULTS Overall, 17 patients with SRAD with a mean age of 38.6 years (SD = 8.3) were identified. Eleven patients were male and 14 were white. The most common presenting symptom was excruciating sudden-onset flank pain ipsilateral to the site of dissection. Fibromuscular dysplasia, Ehlers-Danlos and polyarteritis nodosa were present in 4, 4 and 1 patients, respectively. After adjusting in a multivariable model, the case group was more likely to report history of hypertension, cancer and connective tissue disorders (P < 0.001), and less likely to have obesity (BMI ≥30 kg/m(2)) compared with the general population. Supportive medical treatment, endovascular intervention and surgery were required in 8, 5 and 4 cases, respectively. After discharge from the hospital, hypertension was adequately controlled in all the patients but one. CONCLUSION SRAD may be part of a syndrome having multi-organ involvement. With appropriate medical or surgical management, long-term clinical outcome appears favorable.
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Affiliation(s)
- Farsad Afshinnia
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Abdel-Kerim A, Cassagnes L, Alfidja A, Gageanu C, Favrolt G, Dumousset E, Ravel A, Boyer L, Chabrot P. Management of isolated non-traumatic renal artery dissection: report of four cases. Acta Radiol 2012; 53:401-5. [PMID: 22517982 DOI: 10.1258/ar.2012.110303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. PURPOSE To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. MATERIAL AND METHODS From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34-48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. RESULTS Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. CONCLUSION Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.
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Affiliation(s)
- Amr Abdel-Kerim
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
- Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria University, Alexandria, Egypt
| | - Lucie Cassagnes
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Agaicha Alfidja
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Cristian Gageanu
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Gregory Favrolt
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Eric Dumousset
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Anne Ravel
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Louis Boyer
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Pascal Chabrot
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
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A novel point mutation in type III collagen gene resulting in exon 24 skipping in a case of vascular type Ehlers-Danlos syndrome. Arch Dermatol Res 2008; 300:525-9. [DOI: 10.1007/s00403-008-0884-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 08/04/2008] [Accepted: 08/22/2008] [Indexed: 11/26/2022]
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Abstract
Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.
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Affiliation(s)
- Kyung Pyo Kang
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Sik Lee
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Won Kim
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Gong Yong Jin
- Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University Medical School, Daejeon, Korea
| | - Il Yong Yun
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kwang Park
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
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