Successful rescue from kidney failure with delayed catheter-directed intervention after catastrophic bilateral kidney paradoxical thromboembolism

Abstract

A 62-year-old man presented with acute abdominal and flank pain, oligoanuria and severe acute kidney injury. Unenhanced CT imaging did not detect urolithiasis or hydronephrosis. There was an early blood pressure surge followed by an intense inflammatory response, with a rise in peripheral blood leucocytes and C reactive protein. His urinalysis was bland but the serum lactate dehydrogenase was markedly elevated. CT angiograms demonstrated multiple pulmonary emboli and bilateral renal artery thromboembolism, with occlusion of the left main renal artery. Despite an 88-hour delay from pain onset, catheter-directed thrombolysis and thromboaspiration of both renal arteries were successfully performed, allowing the patient to recover enough kidney function to cease haemodialysis. A patent foramen ovale with right-to-left shunting was discovered, and paradoxical embolism was suspected as the cause of renal infarction. The benefit of catheter-directed reperfusion after prolonged bilateral renal ischaemia is not easily predicted by the severity or duration of acute kidney injury alone.

Vacuum-Assisted Thrombo-Aspiration for Paradoxical Embolism in Left Renal Artery: A Case Report and Literature Review

“…We reviewed English literature on mechanical and pharmacomechanical thrombectomy in patients with renal artery embolisms. We identified nine similar cases (Table 1) [6,[9][10][11][12][13][14][15][16]. Patients with thrombosed renal arteries due to atherosclerosis or hypercoagulable states, thrombosed renal side branches of aortic endografts, occlusion of renal transplant arteries, or aortorenal bypasses were excluded.…”

Patent Foramen Ovale Complicated With Renal Infarction and Pulmonary Embolism: A Case Report With Literature Review

“…A PubMed search using the keywords (Paradoxical embolism) (renal infarction) and (pulmonary embolism) identified only nine cases [8][9][10][11][12][13][14][15][16]. A summary of these cases is presented in Table 2.…”

A Massive Renal Infarction Due to Atheroemboli: A Case Report

“…Still, if the blockage has lasted longer than 24 hours, it should only be considered if the patient experiences renal failure, persistent flank pain, or new/worsening hypertension [ 16 ]. Revascularization may also be necessary in cases of renal infarction associated with arterial dissection [ 17 ].…”