RENAL-ARTERY DISSECTION CAUSING RENAL INFARCTION IN OTHERWISE HEALTHY-MEN

Arterial dissection is usually associated with pathological states suc h as malignant hypertension, severe atherosclerosis, severe trauma, Ma rfan syndrome, or Ehlers-Danlos syndrome, However, we report three cas es in which renal artery dissection occurred in otherwise healthy, nor motensive men. In two cases, the onset of symptoms of renal artery dis section was coincident with an unusual degree of physical activity, In the third case, the symptoms occurred while the patient was sitting b ut during a stressful business meeting. In each case, the patient expe rienced severe unilateral flank pain. Urolithiasis was suspected, but intravenous pyelography showed only ipsilateral impaired renal cortica l perfusion, and the urinalyses showed no hematuria, The diagnosis of renaI artery dissection was established by arteriography in two cases and by nephrectomy in one case. The latter case showed fibromuscular d ysplasia by arteriography performed after the nephrectomy. The other t wo cases showed no evidence of fibromuscular dysplasia. We conclude th at spontaneous renal artery dissection can occur in otherwise healthy individuals. Our experience and the reports of others indicate that th is condition occurs mainly in men, conservative (nonsurgical) manageme nt is generally indicated, and the long-term prognosis is generally ex cellent, in some patients, an unusual degree of physical exertion migh t be the cause of renal artery dissection. (C) 1997 by the National Ki dney Foundation, Inc.