Acute occlusion of the renal artery: an underdiagnosed and treatable pathology

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.