Management of isolated non-traumatic renal artery dissection: report of four cases

Abstract

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.

Renal Artery Dissection in a Patient With Degenerative Scoliosis: A Rare Complication Caused by Lumbar Vertebra Osteophyte

“…Isolated nontraumatic RAD with unknown underlying cause is a rare condition. 1,5 In the literature, spontaneous RAD is defined as a dissection of the renal artery without underlying vascular disease, renal artery intervention, or trauma and approximately 200 isolated RAD cases have been reported. Spontaneous RAD is more frequently observed in males between the fourth and sixth decades of life.…”

“…The dissection may go unnoticed or present with flank pain, hypertension, deteriorating renal function, hematuria, and increased lactate dehydrogenase in serum. 1,8 Because of this, spontaneous RAD may be confused with more frequently seen diseases such as ureterolithiasis and acute pyelonephritis, and therefore, the diagnosis may be delayed.…”

“…Endovascular treatment or surgical reconstruction should be considered if hemodynamically significant occlusion of the renal arteries, intractable severe hypertension, and/or a significant deterioration of renal function are present. 1 –3,8,11 Self-expanding stents or covered stents may be preferred for endovascular treatment according to the dissection type. 2 Open arterial reconstruction is advised in cases when endovascular treatment is not possible.…”

“…Renal artery dissection (RAD) is generally associated with renal artery intervention or blunt abdominal trauma or secondary to aortic dissection. 1 Isolated spontaneous RAD without a known trauma is rare. Malignant hypertension, atherosclerosis, severe physical exertion, fibromuscular dysplasia, Marfan syndrome, Ehlers-Danlos syndrome, vasculitis, and cocaine abuse are notable risk factors for RAD.…”

Spontaneous renal artery dissection presenting as an aortic dissection: a case report

“…Other cases involved medical treatment such as antihypertensive medications, pain control, and anticoagulation or antiplatelet agents. One case series of four patients, three of whom had dissections treated with conservative medical management, found that at 1-month follow-up after treatment with enoxaparin and aspirin, all three patients treated with medical management had normal kidney function, normal blood pressure, and had revascularization of the majority of their kidneys [8]. Another two cases of spontaneous renal dissection, which had only caused ischemia to a fraction of the kidney or were not associated with ischemia, were both successfully treated with conservative medical management involving anticoagulation and antiplatelet agents with a good outcome [9, 10].…”