Spontaneous Renal Artery Dissection Complicated by Renal Infarction: Three Case Reports

Abstract

Spontaneous renal artery dissection (SRAD) is a rare disease entity. The diagnosis is usually delayed because clinical presentation is non-specific. We report three cases of symptomatic SRAD complicated by renal infarction which occurred in previously healthy middle-aged male patients. They visited the hospital due to acute abdominal or flank pain. They had no specific underlying disease or trauma history. The laboratory tests and physical examination were normal. They were not suspected of having SRAD initially, but computed tomography (CT) revealed dissection of the renal artery with distal hypoperfusion leading to renal infarction. They were treated conservatively with anticoagulation and/or antiplatelets for 6 months. They had a 6-month regular follow-up with CT, where resolution was confirmed in one patient and all patients remained asymptomatic. These cases emphasize the importance of clinical suspicion of SRAD in previously healthy patients who complain of abdominal pain without specific findings on initial investigation.

Aortic dissection or spontaneous renal artery dissection, a rare diagnosis?

“…In some cases, endovascular treatment may be considered for patients with worsening blood pressure and/or a worsening renal function [8]. Surgical management, such as aorto-renal bypass, has also been suggested for the treatment of renovascular hypertension and acute occlusion [9].…”

Spontaneous renal artery dissection associated with sexual intercourse: a case report

“…Some physical activities reported to be associated with SRAD are practicing golf, weight lifting, marathon running, and other sporting activities. 7 , 9 , 10 The exact mechanism of dissection in these conditions is not well understood, but thought to be due to stretching of the renal artery and intimal injury with subsequent dissection of the vessel wall and thrombosis. To the best of our knowledge, SRAD after sexual intercourse has not been reported before.…”

Spontaneous renal artery dissection masquerading as urinary tract infection

“…On Laboratory evaluation, patients are frequently found to have increased creatinine values, leucocytosis and elevated serum LDH levels, suggesting renal parenchymal loss 7. Renal arterial dissection results in haematoma formation between the intima and medial layers often resulting in severe stenosis leading to renal ischaemia, elevated renin secretion and consequent uncontrolled hypertension 5. Given the rarity of the disease and the absence of specific treatment guidelines, the evidence for management is largely derived from case reports and case series 5 8 9.…”