Renal Infarction Secondary to Renal Artery Ectasia

Case Report

Austin J Clin Case Rep. 2014;1(6): 1028.

Renal Infarction Secondary to Renal Artery Ectasia

Yedla S and Ansari N*

Department of Medicine, Jacobi Medical Center, USA

*Corresponding author: Ansari N, Department of Medicine, Division of Nephrology, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY. 10461, USA

Received: June 14, 2014; Accepted: July 14, 2014; Published: July 17, 2014


We describe a case of renal infarction secondary to renal artery ectasia. A 45 year old male presented to emergency department with sudden onset of left flank pain for one day. Physical examination was significant for tenderness in left upper quadrant and left costovertebral angle with no guarding. Laboratory tests revealed leukocytosis, creatinine 1.4mg/dl, high LDH, and microscopic hematuria. CT abdomen revealed wedge shaped hypodensities in left kidney compatible with renal infarction and focal nonenhancing regions within left renal artery suspicious for thrombus. Subsequent work-up was negative for cardiac and hypercoagulable causes of renal infarction. Urine toxic screen was negative for cocaine. Renal angiogram demonstrated bilateral renal artery ectasias, with left upper pole infarction. He was referred to vascular surgery for endovascular/ surgical intervention. Renal infarction typically occurs due to thromboembolic disease but rare causes like renal artery ectasia as in our patient should also be considered in the differential diagnosis.

Keywords: Renal Infarction; Renal artery aneurysm; Renal artery ectasia

Case Presentation

A 46 year old male, with past medical history of peptic ulcer disease (PUD) presented to the emergency department with severe left sided abdominal pain. The pain was colicky in nature, which progressively worsened over next two days. Patient had taken famotidine with no relief. He recalled having had subjective fevers, chills and intermittent dysuria during the week prior to presentation. His social and personal history was not significant.

In emergency room his vital signs showed temperature 101.4F, heart rate 106 per minute, respiratory rate 18per minute, blood pressure 152/107mmHg, O2 saturation 97% (room air). On physical examination, he appeared extremely uncomfortable and diaphoretic lying flat in bed. Heart and lung examinations were normal. Abdomen was distended and hyperresonant with tenderness in left upper and lower quadrants. Left costovertebral tenderness was elicited on examination. His laboratory data revealed WBC 12.6 × 109/l, creatinine 1.4 mg/dl, mild transaminitis, high lactate dehydrogenase (LDH-574U/L), and cholesterol 298 mg/dl, LDL 195 mg/dl, triglycerides 205 mg/dl, and HDL 53 mg/dl. Urine cocaine was absent on toxicology screen. EKG showed normal sinus rhythm. Urinalysis was positive for blood with no proteinuria. Sepsis work up was negative. CT abdomen showed wedge shaped hypodense areas along the medial aspect of the left kidney with perinephric stranding and non contrast enhancing regions within the left renal artery suspicious for thrombotic plaque (Figure 1). Further workup for renal infarction did not reveal any hypercoagulable state. Vasculitis work up was inconclusive. Holter monitoring showed normal sinus rhythm. Transthoracic and transesophageal echocardiogram did not show any evidence of vegetations or clots. Carotid duplex revealed no atherosclerotic plaque in both carotid arteries. Diagnostic renal angiogram demonstrated bilateral renal artery ectasia of 8mm in mid left renal artery and 6mm in left upper branch with left upper pole infarct. Right renal artery showed an aneurysm in mid portion measuring 11mm (Figure 2). The patient on admission was started on enoxaparin and transitioned to coumadin. He was discharged on aspirin and plavix due to the thrombotic event and referred to vascular surgery for further surgical intervention. Unfortunately the patient did not follow up with medical appointments after discharge from the hospital.

Citation: Yedla S and Ansari N. Renal Infarction Secondary to Renal Artery Ectasia. Austin J Clin Case Rep. 2014;1(6): 1028. ISSN 2381-912X