C61 Renal artery embolism Eur Urol Suppl 2013;12;e1169

Cerny J.1, Petrik A.1, Uhlirova I.2, Hes K.3

1Ceske Budejovice Hospital, Dept. of Urology, Ceské Budejovice, Czech Republic, 2Strakonice Hospital, Dept. of General

Surgery, Strakonice, Czech Republic, 3Ceske Budejovice Hospital, Dept. of Radiology, Ceske Budejovice, Czech Republic

INTRODUCTION & OBJECTIVES: The aim of the work is to present a case of renal artery embolism.

MATERIAL & METHODS: Presentation of a case report of patient with renal infarction on the basis of a blood clot emboli in

hypercoagulopathy.

RESULTS: 49 year-old female patient without any urological or hematological history was admitted at the surgical department

of the district hospital for a flank pain, mild fever and nausea. At the time of admission there was leukocytosis, erythrocyturia,

CRP 19.7 in basic lab tests. Sonographic abdomen examination, KUB and VUG were without any pathological findings. Cause

of sustaining complaints CT VUG was performed, showing occlusion of a left renal artery due to arterial thrombus, upper half

kidney infarction with obvious persistent excretory renal function. The lower pole of the kidney is supplied by an aberrant artery

without changes. Immediately after diagnosis, 38 hours after the first symptoms, the patient was transported to superior medical

care centre for radiological renal artery revascularization. Minimally invasive left renal artery clot evacuation was

performed without any complications. In 24 hour apart the controll angiography shew a good left renal artery patency, with a

persistent residual infarction of a cranial half of the kidney. To find out the aethiology of the renal embolus pacient underwent

cardiac examination, which was without pathological findings. Hematology tests discovered hypercoagulopathy. An

anticoagulant and antiplatelet therapy was initiated. Patient was discharged to homecare on the 4th day of hospitalization without

any difficulties. Following genetic testing revealed homozygous mutation of the gene encoding prothrombin (G20210A). In the

distance of six weeks CT arteriography was performed, where two well forward arteries with ischaemic parenchymal changes in

the upper half of the kidney were displayed. After 3 months the decrease level of a relative left kidney function at 35% with the

cranial defect was confirmed on renal scintigraphy scan. The patient has been set on long term anticoagulant therapy.

CONCLUSIONS: Kidney infarction is a rare and therefore often neglected diagnosis. Early revasularisation of the renal artery

by the minimally radiological intervention reduces the likelihood of irreversible damage to the renal parenchyma. The fact that

renal function was not fully altered despite the 38-hour delay of revascularisation, can give an evidence of partial closure and

presence of the aberrant renal artery.