Acute renal artery embolisation: role of local catheter-based intra-arterial thrombolysis

Abstract

A 45-year-old man without previous comorbidity presented to us with acute onset right-sided flank pain for last 14 hours. His general physical and systemic examination was unremarkable, and there were no clinical signs of peritonitis. The ultrasonography did not reveal any evidence of nephrolithiasis or hydronephrosis. His contrast-enhanced CT scan revealed hypoattenuated areas of right kidney and evidence of right renal artery thrombosis. He was immediately shifted to cardiac catheterisation lab, and his renal angiography showed thrombotic occlusion of right renal artery. The bolus dose of streptokinase (250 000 IU) was given locally in renal artery by right judkins catheter followed by systemic infusion of streptokinase (100 000 IU/hour) for 24 hours. After that he was started on low molecular weight heparin. Repeat renal angiography done after 5 days showed completely normal right renal artery. His cardiac and thrombophilia work up was negative, and he was discharged on antiplatelets, oral anticoagulants and statins.

Rotarex mechanical thrombectomy in renal artery thrombosis: A case report

“…Renal infarction is a rare condition, with an estimated incidence in the Emergency Department of 0.004%[ 7 ]. RAT may be related to atrial fibrillation[ 4 ]. In addition, any renal artery damage caused by endovascular treatment or trauma may also lead to thrombosis, and RAT may also occur as a result of renal artery stenosis.…”

“…Clinical manifestations of RAT include acute onset of flank pain or lower back pain, and hematuria without signs of peritonitis[ 4 ]. The diagnosis of renal artery thrombosis is often delayed or missed due to both the rarity of the disease and its non-specific clinical presentation, and has become a diagnostic challenge in the Emergency Department.…”

“…Most of the literature on this disease is published in case reports and retrospective studies[ 1 , 2 ]. Because of its low incidence and atypical symptoms, and as it usually manifests as abdominal pain similar to acute pyelonephritis or renal colic, acute RAT is easily misdiagnosed[ 3 , 4 ]. Early diagnosis and emergent treatment can prevent the loss of renal function and the development of hypertension.…”

Acute renal artery thrombosis treated with combination use of multiple interventional techniques

“…Acute Renal artery thrombosis is a rare condition, which may lead to renal dysfunction, with an incidence of 0.004% to 0.007% reported in the emergency department [1,2], although its postmortem incidence is 1.4% [3]. As r eported in other cases, the cause of renal artery thrombosis is usually systemic embolization and rarely secondary to in situ thrombosis [4,5].…”

Rare Clinical Cases of Renal Artery Thrombosis

“…6,28 A combined application of both methods is also possible. 29 However, thrombolytic therapy is limited in time (90-180 minutes from the thrombosis development), 30 while most cases are diagnosed within the first 24 hours. 22 Stenting after thrombectomy is less common.…”