Acute occlusion of the renal artery is an uncommon cause of renal failure b
ut in an be unnoticed and so it is underdiagnosed. The salvage of renal fun
ction is possible following anticoagulation, thrombolytic therapy, operativ
e intervention or percutaneous transluminal recanalization. Early local fib
rinolytic treatment is an effective alternative to operative intervention i
n selected cases.
Between july-1994 and october-1998, twelve patients were diagnosed as havin
g acute occlusion of the renal artery, seven females and five males, aged b
etween 30 and 82 years. Patients were admitted at out hospital's emergency
department for exploration of abdominal or flank pain. This represent 4 cas
ed/10(6) inhabitants/year and 0.5% of admissions in Nephrology Service, 2%
without dialysis and transplant patients admissions. They were initially di
agnosed on a clinical basis as having other abdominal pathology: renal coli
c (7 patients), biliary colic (2), obstructive uropathy (1) pyelonephritis
(1) and acute cholecystitis (li.
Increased serum levels of lactic dehydrogenase (LDH) (100%), microscopic he
maturia 180%) and proteinuria (70%) were the most frequent laboratory featu
res found. In six out of nine patiens renal failure was observed. Two patie
nts had acute anuria. Computed tomography with contrast material or isotopi
c flow scan were the first step diagnostic procedures. Diagnosis was confir
med by renal arteriography.
Eight cases had an embolic origin and 4 thrombotic in all cases a single ki
dney was affected, ten of them with a contralateral functioning kidney. Loc
al fibrinolysis with urokinase was the treatment five of the seven cases in
which the sire of arterial occlusion was located by angiography. In one pa
tient surgical repair of occlusion was performed because he had only one fu
nctioning kidney. Anticoagulant treatment was given in embolic cases and an
tiplatelet therapy in thrombotic ones. In the follow-up of the seven patien
ts with renal failure, two showed restoration of renal function, in one no
further deterioration was observed and it deteriorated in the other four tw
o of whom needed dialysis an did not recover renal function.
Conclusion: Acute occlusion of the renal artery must be suspected in every
patient with abdominal pain with microhematuria and high LDH. Early diagnos
is and treatment is very important. Fibrinolytic treatment may be an effect
ive alternative to surgical treatment.