Acute renal failure due to acute bilateral renal artery thrombosis: successful surgical revascularization after prolonged anuria

Successful revascularisation following delayed presentation of bilateral renal artery thrombosis after blunt abdominal trauma

Traumatic blunt abdominal bilateral renal artery thrombosis is a rare entity leading to end stage renal disease and has significant morbidity due to renal replacement therapy. Previously many attempts of revascularisation beyond 24 h have led to failure. We report a case of delayed presentation of bilateral renal artery thrombosis in which revascularisation was attempted beyond 24 h and was successful in terms of patient becoming dialysis-free.

Dramatic improvement of rapidly progressing acute renal failure and severe hypertension after bilateral renal artery stenting

In this case report, we describe an 83-year-old man with bilateral renal artery stenosis who had rapidly progressing acute renal failure and severe hypertension. These conditions improved dramatically after bilateral renal artery stenting. Renal artery stenosis can cause renal failure, hypertension, and heart failure, leading to a poorer life prognosis. If renal artery stenosis is found as a cause of acute renal failure, severe hypertension, or heart failure, it is useful to perform revascularization as soon as possible. Revascularization by stenting has a high success rate and is expected to improve the condition remarkably.

Delayed angioplasty after renal thrombosis

When renal arterial thrombosis occurs, the etiologic process plays an important role in the impact of ischemia on renal tissue. If the occlusion is caused by trauma, infarction rapidly occurs. However, when renal arterial thrombosis results from other processes, collateral vessels may develop and thus enables a prolonged ischemia without necrosis. The following is a case report of an acute renal failure caused by renal arterial thrombosis of a single functional kidney, which had a favorable outcome despite delayed treatment by percutaneous angioplasty. This report suggests that detection by ultrasonography of a venous renal flow could be of significant value to assess a collateral vascularization and thus should require an arteriography with angioplasty even after a delayed presentation.

Endovascular treatment of multiple visceral artery paradoxical emboli with mechanical and pharmacological thrombolysis

PURPOSE

To report a case of paradoxical emboli to multiple visceral vessels treated with both mechanical (AngioJet device) and pharmacological (urokinase) thrombolysis.

METHODS AND RESULTS

A 72-year-old man presented with a 48-hour history of symptomatic right renal ischemia, which was treated with heparinization. Five days later, an abrupt creatinine elevation prompted arteriography, which demonstrated thromboembolism of the superior mesenteric artery (SMA) and both renal arteries. The AngioJet aspiration device was employed to successfully remove the clot from the SMA; urokinase infusion restored flow to the left kidney. At the 16-month follow-up evaluation, the patient was normotensive without medication and had a stable creatinine (1.4 mg/dL).

CONCLUSIONS

Because of its speed and minimal morbidity, the AngioJet device may be an attractive alternative to surgical embolectomy or pharmacological thrombolysis in highly selected cases of acute visceral artery thromboembolism.

Bilateral renal artery occlusion: an unusual presentation of atrial fibrillation and hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy predisposes patients to atrial fibrillation and the development of systemic embolization. We describe a rare case of bilateral renal artery thrombosis which presented as acute renal failure requiring dialysis. The patient was successfully treated with a selective, continuous infusion of urokinase which resulted in the return of adequate renal function.

Local infusion of fibrinolytic agents for acute renal artery thromboembolism: report of ten cases

Management of acute renal artery occlusion remains a therapeutic challenge. We report our experience with 10 cases of acute renal artery occlusion treated primarily by local infusion of fibrinolytic agents. Renal artery occlusion occurred as a result of thrombosis of a stenosed vessel in three cases, from renal artery embolism in two cases, as a complication of percutaneous transluminal angioplasty in four cases, and in association with aortic occlusion in one case. Flank pain was present in all cases and hematuria in four cases. Acute renal failure was seen at the time of presentation in four cases (one case from bilateral occlusion and three cases from an associated nonfunctioning contralateral kidney). Diagnosis was confirmed by renal isotope scanning and arteriography in all cases. All patients were treated by selective infusion of streptokinase or urokinase into the occluded renal arteries. In five cases this was combined with balloon catheter angioplasty. Therapy was initiated within 24 hours from the onset of symptoms in three cases, within 3 days in four cases, within 6 days in two cases, and after 5 weeks in one case. Successful revascularization was initially achieved in 7 of the 10 cases by arteriographic criteria. Rethrombosis occurred in one patient after 3 days and fibrinolytic therapy was repeated successfully. Renal function was restored in one of the four patients presenting with acute renal failure. One complication necessitating resection occurred as a result of fibrinolytic therapy in the form of acute mesenteric embolism with descending colon infarction. No major bleeding complications were encountered and there were no deaths in this group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)