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Kennedy J, Rouse J, Roth M. Spontaneous Renal Artery Dissection in Active Duty Male. Mil Med 2024:usae397. [PMID: 39186546 DOI: 10.1093/milmed/usae397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/29/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024] Open
Abstract
Spontaneous renal artery dissection is a rare condition with nonspecific symptoms that can be challenging to diagnose. We present the case of a 25-year-old male presenting with left flank pain, mild leukocytosis, and a benign urinalysis found to have renal artery dissection on computed tomography angiogram. The patient's condition improved following conservative management with anticoagulants. This case demonstrates that Spontaneous renal artery dissection may be a potential cause of renal artery infarction in young, previously healthy patients.
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Affiliation(s)
| | - Jake Rouse
- Family Medicine Department, Naval Hospital Jacksonville, Jacksonville, FL 32214, USA
| | - Michael Roth
- Internal Medicine Department, Navy Medical Readiness and Training Center Portsmouth, Portsmouth, VA 23701, USA
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Dicks AB, Elgendy IY, Thondapu V, Ghoshhajra B, Waller HD, Rubio M, Schainfeld RM, Weinberg I. Clinical characteristics, treatment and outcomes of patients with spontaneous renal artery dissections. J Nephrol 2023; 36:377-384. [PMID: 36178591 DOI: 10.1007/s40620-022-01444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The natural history and optimal management of spontaneous renal artery dissections (SRADs) are poorly understood. We compared baseline characteristics, presentation, management, and outcomes between patients with symptomatic versus asymptomatic SRADs. METHODS We performed a retrospective review of medical charts for patients diagnosed with SRAD at a single, tertiary care center. Patients were identified using billing codes. Patient demographics, medical history, clinical presentation, treatment, and follow up were recorded. We compared patients based on presence or absence of symptoms at the time of SRAD diagnosis. RESULTS A total of 125 patients were included; 73 (58.4%) patients had symptoms at the time of SRAD diagnosis. Symptomatic patients were younger at the time of diagnosis (47.4 vs. 54.3 years, p = 0.008) and more likely male (74.0% vs. 44.2%, p = 0.005). Most patients received medical therapy (93.2% vs. 82.6%, p = 0.32). Endovascular therapy utilization was low in both groups (8.2% vs. 7.7%, p = 0.9). Outcomes between the two groups were comparable; renal function remained stable, and mortality was rare. CONCLUSION Most patients who presented with SRAD were treated with medical therapy alone and usually experienced a benign course. Further studies are needed to understand the pathophysiology and natural history of renal artery dissections.
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Affiliation(s)
- Andrew B Dicks
- Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Vikas Thondapu
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold D Waller
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Manolo Rubio
- Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Robert M Schainfeld
- Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ido Weinberg
- Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Bax M, Romanov V, Junday K, Giannoulatou E, Martinac B, Kovacic JC, Liu R, Iismaa SE, Graham RM. Arterial dissections: Common features and new perspectives. Front Cardiovasc Med 2022; 9:1055862. [PMID: 36561772 PMCID: PMC9763901 DOI: 10.3389/fcvm.2022.1055862] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations - such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.
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Affiliation(s)
- Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Valentin Romanov
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Boris Martinac
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY, United States
| | - Renjing Liu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
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Papazoglou DD, Weiss S, Kissling P. [Rare cause of renal infarction in a 28-year-old male patient]. Internist (Berl) 2021; 63:221-223. [PMID: 34654934 PMCID: PMC8518887 DOI: 10.1007/s00108-021-01186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
Es wird über den Fall eines 28-jährigen Patienten mit einem Niereninfarkt aufgrund eines embolisierenden Aneurysmas nach traumatischer Dissektion einer Nierensegmentarterie berichtet. Er stellte sich 1,5 Jahre nach einem Motorradunfall mit Abdominal- und Flankenschmerzen vor. C‑reaktives Protein und Laktat-Dehydrogenase waren erhöht. Die Diagnose wurde mittels computertomographischer Angiographie gestellt. Weitere Ursachen eines Niereninfarkts wurden ausgeschlossen. Nach interdisziplinärer Besprechung entschieden wir uns bei jungem und sportlich aktivem Patienten für ein interventionelles Coiling, um eine langfristige Antikoagulation zu vermeiden.
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Affiliation(s)
- Dimitrios David Papazoglou
- Departement Chirurgie, Gefässzentrum soH, Bürgerspital Solothurn, Schöngrünstraße 42, 4500, Solothurn, Schweiz.
| | - Salome Weiss
- Universitätsklinik für Herz- und Gefässchirurgie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Pascal Kissling
- Departement Chirurgie, Gefässzentrum soH, Bürgerspital Solothurn, Schöngrünstraße 42, 4500, Solothurn, Schweiz
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