ACUTE OLIGURIC RENAL-FAILURE ASSOCIATED WITH UNILATERAL RENAL EMBOLISM - A SUCCESSFUL TREATMENT WITH ILOPROST

A 66-year-old woman presented with acute-onset rapid atrial fibrillati on and right upper quadrant pain which had appeared 24 h prior to admi ssion. The patient also manifested acute oliguric renal failure (serum creatinine 6.9 mg/dl). Selective renal angiography revealed total occ lusion of the right renal artery with normal visualization of the left kidney vasculature. The patient tvas treated with intra-arterial urok inase and intravenous heparin, with no response. Intravenous administr ation of the prostacyclin analogue, iloprost, resulted in rapid resolu tion (within hours) of the oliguric acute renal failure, in spite of t he continuing presence of a nonfunctioning right kidney. We conclude t hat the etiology of the acute renal insult in this patient is probably related to unilateral renal arterial embolization accompanied by arte rial spasm of the unaffected kidney. The contralateral vasospasm can b e reversed by iloprost, which then leads to a rapid recovery from acut e renal failure. We are unaware of prior reports documenting the benef icial effect of iloprost in a clinical setting as described here.