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Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.

INTRODUCTION Renal sympathetic denervation (RSDN) is an alternate management approach for refractory ventricular arrhythmias (VAs). We aimed to perform a systematic review of clinical outcomes on the impact of RSDN on refractory VA patients. METHODS A systematic search without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov from inception to August 18, 2020, was performed for the studies that reported outcomes in patients who underwent RSDN for VA. The outcomes studied were-(1) recurrent VA; and (2) all-cause mortality. RESULTS Five studies (from 2014 to 2018) with a total of 51 VA patients met study inclusion criteria. The mean age was 61.92 ± 11.76 years, and 78.4% were men. The pooled incidence of short-term (3 months or less) and long-term (more than 3 months) VA recurrence was 63.85% (95% CI 16.75 to 99.32) and 10.52% (95% CI 0.14 to 28.75), respectively. When stratified by the number of VA episodes, there was a significant reduction in mean VA episodes (SMD -3.79, 95% CI -6.59 to -0.98, p

Stent-graft placement is an important treatment for traumatic renal artery dissection, but it may occasionally be technically difficult to advance a catheter through the lesion of the dissection due to severe stenosis of the true rumen. A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has recently become available, and it contributes to super-selective catheterization. We thought this system may be useful for passing catheters through the dissection. We herein report a 30-year-old male patient with traumatic renal artery dissection, who was successfully treated by stent-graft placement using the triaxial system.

Spontaneous renal artery dissection (SRAD) causing bilateral renal infarction is a rare condition. It may present with nonspecific symptoms, resulting in delayed diagnosis. We report a case of SRAD in an adult male who presented with flank pain and fever. The patient was initially worked up for possible pyelonephritis, which came back negative. Later, a diagnosis of SRAD with bilateral renal infarction was made on contrast-enhanced computed tomography (CT) abdomen followed by CT angiogram. The patient was treated with rivaroxaban and antihypertensive therapy. He was followed up for 12 months after the initial presentation and repeat imaging showed no new infarcts and a stable renal function.

Arterial hypertension and chronic kidney disease are mutually interconnected. Uncontrolled arterial hypertension along with diabetes is one of the two most common causes of end-stage chronic kidney disease. On the other hand, chronic kidney disease, as well as renal artery stenosis, results in the development of arterial hypertension. Hypertensive crisis with target-organ damage, also known as a hypertensive emergency, is a serious arterial hypertension complication which is however becoming less frequent. It requires urgent parenteral antihypertensive treatment adjusted to the values of arterial hypertension and accompanying clinical signs. Damage can manifest on numerous organ systems primarily eyes, brain, cardiovascular system, and the kidneys. This is a case report of a patient who presented with hypertensive crisis and kidney damage and was eventually diagnosed with abdominal aortic dissection expanding into the renal arteries, but without typical clinical presentation of stabbing pain. MSCT aortography, despite the risk of progression of renal damage due to the effect of contrast agent, allowed us to set definitive diagnosis and clarify the aetiology of kidney damage and resistant arterial hypertension., Arterijska hipertenzija i kronična bubrežna bolest uzročno-posljedično su povezane. Neregulirana arterijska hipertenzija uz šećernu bolest jedan je od dva najčešća uzroka završnog stadija kronične bubrežne bolesti, a s druge strane, kronična bubrežna bolest, jednako kao i bolest bubrežnih arterija, dovodi do razvoja arterijske hipertenzije. Hipertenzivna kriza s oštećenjem ciljnih organa, takozvana hipertenzivna emergencija, ozbiljna je komplikacija arterijske hipertenzije koja se ipak sve rjeđa viđa. Iziskuje hitno parenteralno antihipertenzivno liječenje prilagođeno prema vrijednostima arterijskog tlaka i pridruženim kliničkim znako-vima. Oštećenja se mogu manifestirati na brojnim organskim sustavima, prvenstveno očima, mozgu, kardiovaskularnom sustavu i bubrezima. Prikazan je slučaj bolesnika s hipertenzivnom krizom uz bubrežno oštećenje u kojeg se obradom izdiferencirala disek-cija abdominalne aorte sa širenjem u renalne arterije, no bez tipične kliničke slike s parajućim bolovima. Učinjenom kontrastnom pretragom, unatoč riziku, postavljena je definitivna dijagnoza i razjašnjena je etiologija bubrežnog oštećenja i uzrok pogoršanja arterijske hipertenzije.

Renal infarction and renal artery dissection are rare and understudied entities whose management remains largely based on expert opinion and local experience. In 2018, Faucon et al had already shed light on the nosology, tentative management, and follow-up of renal infarction based on a large retrospective study including 186 patients. In this issue of Hypertension, they provide new insights, this time focusing on a subgroup of 61 patients without known underlying vascular disease in whom renal infarction was due to spontaneous renal artery dissection. [...]

Introduction. Spontaneous Renal Artery Dissection (SRAD) is a rare and often unrecognized clinical entity, which only accounts for 1-2% of all arterial dissections. Due to its rarity, it may be difficult to diagnose and treat. Methods. All patients affected by SRAD and admitted in our Unit in the last year were included. Results. Five patients presented with renal infarction due to SRAD were admitted in our Unit in 2020. Patient Characheristics are shown in Table 1. At onset, all suffered from abdominal pain and high blood pressure. In all patients renal function was normal. Abdomen computed tomography angiography (CTA) was diagnostic in all patients (Figure 1). They were treated with antihypertensive drugs and systemic anticoagulation followed by oral anticoagulants. At 3 month-follow-up, all patients became normotensive and partial or total renal artery recanalization were found (Figure 2). Conclusions. In our experience, SRAD seems to be not very rare in young and healthy patients with minimal comorbidities. Abdomen CTA is one of the “gold standard” non invasive diagnostic method. In patient treated with conservative medical therapy renal outcome is favourable. More studies are necessary to find underlying causes.

Spontaneous renal artery dissection (SRAD) is a rare entity and the management of this disease has not been established. A 54-year-old man presented with severe flank pain, and contrast-enhanced computed tomography images suggested SRAD in his left renal artery. After two weeks of conservative treatment, stents were placed in the renal artery. The pre- and post-procedural renal function was independently assessed by renography. After stenting, his left renal function recovered from the renal failure pattern. Renal artery stenting in an acute phase of SRAD may salvage the renal function, even if it appears to be non-functioning.

We aimed to compare the characteristics of the patients with renal infarction related to nontrauma renal artery dissection (RAD) with versus without an underlying vascular disease and report long-term renal and vascular outcomes, as well as new-onset renal and extra-RADs. Data from 72 consecutive patients with RAD referred to our Hypertension Unit between 2000 and 2015 were analyzed. Radiological data, including a systematic brain-to-pelvis computed tomography angiography, were independently reviewed. Three main causes of RAD were identified at the initial work-up: fibromuscular dysplasia (n=16); dissecting or aneurysmal multisite arterial disease (n=21) not linked to any known vascular disease; and isolated RAD (n=24) without any other arterial lesion. At diagnosis, patients (median age 46 [interquartile range, 40–53] years, 70.5% males, 26.2% preexisting hypertension, 65.6% smokers) had a median blood pressure of 138 (125–152)/87 (78–97) mm Hg. Estimated glomerular filtration rate was 81 (66–95) mL/min per 1.73 m 2 and 18% had renal impairment. Patients were treated with antiplatelet drugs (65.6%), anticoagulant (3.3%). A total of 11.5% underwent angioplasty. No clinical or biological difference was observed between the 3 groups. After 51 (19–92) months follow-up, blood pressure was reduced by 13 (0–29)/9 (3–18) mm Hg; 11.5% of patients had estimated glomerular filtration rate 2 . RAD evolved toward healing (67.2%), aneurysmal dilation (24.6%), or stenosis (8.2%). New-onset RAD was as frequent in dissecting or aneurysmal multisite arterial disease (23.8%) than in fibromuscular dysplasia (25%) group, whereas de novo extrarenal dissection was 6-fold more frequent in dissecting or aneurysmal multisite arterial disease (38.1%) than in fibromuscular dysplasia (6.3%) group. No new event occurred in patients with an initial diagnosis of isolated RAD. Initial diagnostic accuracy using thorough systematic exhaustive explorations of arterial sites helps to stratify the risk of new-onset dissection and adapt monitoring accordingly.

Purpose: Spontaneous isolated renal artery dissection is a very rare but threatening condition that can be difficult to diagnose early due to nonspecific symptoms. The goal of this study is to evaluate the incidence and multidetector computed tomography (MDCT) findings of this rare and important condition.Materials and methods: We retrospectively examined the images of all patients who underwent contrast enhanced abdominal MDCT scans due to various abdominal complaints between July 2017- July 2020. 14000 contrast enhanced MDCT scans were evaluated. Only the isolated renal artery dissections without aortic involvement were included. Age, gender, symptoms, presence of thrombosis or renal parenchymal ischemia-infarct were noted. Average extension of dissection and distance from origin were measured. Results: 8(0,054%) patients had spontaneous isolated renal artery dissection (5M, 3F, age range 43-61 years). The mean distance from origin was 3.7 cm and the average extension was 3.8 cm. 3 patients had kidney infarct with a focal area of decreased perfusion. Only 1 patient underwent digital subtraction angiography. Patients were started on an anticoagulation therapy. No surgical or interventional therapy was deemed necessary. Dissections completely disappeared in patients who could undergo follow-up MDCT.Conclusion: Spontaneous isolated renal artery dissection is a very rare condition. The etiology is not well known. The initial symptoms are generally nonspecific such as severe upper abdomen or flank pain. There are several treatment options available such as medical, surgical or interventional managements. Early diagnose is important to prevent complications. It should be considered in patients with new-onset flank or abdominal pain., Amaç: Spontan izole renal arter diseksiyonu, spesifik olmayan semptomlar nedeniyle erken teşhis edilmesi zor olabilen, çok nadir fakat tehdit edici bir durumdur. Bu çalışmanın amacı, bu nadir ve önemli durumun insidansını ve çok kesitli bilgisayarlı tomografi (ÇKBT) bulgularını değerlendirmektir.Gereç ve Yöntem: Temmuz 2017-Temmuz 2020 tarihleri arasında çeşitli karın şikayetleri nedeniyle kontrastlı abdominal ÇKBT taraması yapılan tüm hastaların görüntülerini retrospektif olarak inceledik. 14000 kontrastlı ÇKBT görüntüsü değerlendirildi. Sadece aort tutulumu olmayan izole renal arter diseksiyonları dahil edildi. Yaş, cinsiyet, semptomlar, tromboz veya renal parankimal iskemi-enfarkt varlığı kaydedildi. Ortalama diseksiyon uzunluğu ve orijinden uzaklık ölçüldü.Bulgular: 8 (% 0,054) hastada spontan izole renal arter diseksiyonu (5E, 3K, yaş aralığı 43-61) vardı. Orjinden ortalama uzaklık 3,7 cm ve ortalama diseke segment uzunluğu 3,8 cm idi. 3 hastada böbrekte parankimal enfarkt vardı. Sadece 1 hastaya dijital substraksiyon anjiyografisi yapıldı. Hastalara antikoagülan tedavi başlandı. Cerrahi veya girişimsel tedaviye gerek görülmedi. ÇKBT takibi yapılabilen hastalarda diseksiyonlar tamamen kayboldu.Sonuç: Spontan izole renal arter diseksiyonu çok nadir görülen bir durumdur. Etiyoloji iyi bilinmemektedir. İlk semptomlar genellikle nonspesifik olup şiddetli karın veya yan ağrısıdır. Tıbbi, cerrahi veya girişimsel yönetimler gibi çeşitli tedavi seçenekleri mevcuttur. Erken teşhis, komplikasyonları önlemek için önemlidir. Yeni başlayan böğür veya karın ağrısı olan hastalarda düşünülmelidir.

The diagnosis of renal infarction is often convoluted due to its non-specific presentation. It can mimic disease processes as disparate as pyelonephritis, diverticulitis, or nephrolithiasis. This case is further complicated by the presence of a pelvic kidney with triplicate arterial input. It is difficult to estimate the incidence of pelvic kidneys as the numerous sources vary wildly in their estimations; however, the paucity information, in and of itself, speaks to the rarity of the condition. In this case, a 58-year-old male presents to the emergency department after experiencing sharp, sudden, and severe groin pain while swinging a golf club. The patient was noted to have an abnormally high systolic blood pressure in the 170s and hematuria, but all other initial labs and assessments were unremarkable. An initial computed tomography scan with intravenous contrast of the abdomen and pelvis showed partial necrosis of a pelvic kidney. Follow-up computed tomography angiography revealed that a dissection in one of the arteries supplying the kidney created an infarction and resultant necrosis. Vessel size, location and time between injury and diagnosis made endovascular intervention impractical. The patient was started on aspirin and Plavix, observed for 3 days and sent home.

Both spontaneous superior mesenteric artery dissection (SMAD) and spontaneous renal artery dissection (SRAD) are very rare conditions. Their etiologies and natural histories are not precisely defined, but they are thought to be associated with underlying conditions. In this report, we describe an extremely rare case of SRAD in a man who had a history of spontaneous SMAD. We successfully treated SRAD with endovascular intervention. Isolated spontaneous SMAD and SRAD are both rare conditions. Their optimal treatment has not been established due to their rare entities, but endovascular treatment is a good option because it can prevent both advancement of infarction and renovascular hypertension, and it has become safer as device technology has improved. Patients with isolated visceral artery dissection should be carefully followed up.

The commonest site of primary dissection involving the visceral vessels is renal arteries; however, spontaneous bilateral renal artery dissection is an extremely rare entity. Spontaneous renal artery dissection (SRAD) is rarely a cause of renovascular hypertension. Segmental arterial mediolysis is a rare arteriopathy of unknown etiology which is a nonatherosclerotic and noninflammatory condition. We report a case of a 51-year-old male patient with spontaneous dissection of bilateral renal arteries with clinical, laboratory, and angiographic findings consistent with segmental artery mediolysis. Early diagnosis and treatment of this condition will decrease morbidity and mortality. Keywords: Segmental arterial mediolysis, Dissection, Renal hypertension

Spontaneous renal artery dissection (SRAD) is a rare disease with approximately 200 cases reported in the literature. The severity of renal compromise, the anatomic location of the dissection, and the presence of uncontrollable hypertension are used to guide the initial management of SRAD. However, there are no reported guidelines for managing the progression of SRAD after acute failure of medical management. In this case, a 40-year-old man with a recently diagnosed SRAD was managed appropriately with therapeutic anticoagulation, yet presented with progression of his dissection and a new acute renal infarct. A covered endovascular stent was used to successfully control dissection progression and prevent further renal compromise.

Spontaneous renal artery dissection is a rare cause of renal infarction and can be a diagnostic challenge at times, necessitating high index of suspicion. Other common underlying causes, especially thromboembolic phenomena, need to be considered and investigated first before making this uncommon diagnosis with vascular imaging studies. Very few cases did report strenuous exercise as a predisposing factor for the development of spontaneous renal artery dissection, but we believe that sexual intercourse has not been reported before as an underlying precipitating etiology. We report a case of a young male who presented with renal infarction that started during sexual intercourse and was found to have an angiographically proven renal artery dissection.

Constituting less than 25% of all renal artery dissections (RAD), isolated spontaneous renal artery dissection (SRAD) is a rare diagnosis that can cause subsequent renal infarction with impairment. The majority of SRAD cases are idiopathic. Management ranges from conservative, medical to endovascular, and surgical repair. We report a case of a young female on multiple medications who presented with SRAD. She presented with acute abdominal pain and was found to have isolated spontaneous renal artery dissection. The etiology of this patient’s isolated SRAD could possibly be pinned down to her multiple stimulant medications used after the major known causes were ruled out.

Spontaneous renal artery dissection is a rare disease and an uncommon cause of renal infarction. The patient was a man who presented to the emergency room with sudden-onset right flank pain. Computed tomography revealed right renal infarction; thus, anticoagulation was initiated. Renal angiography revealed luminal narrowing of the segmental artery to the superior pole of right kidney without a dissection flap or false lumen. We stopped anticoagulation due to a lack of evidence of thrombi or luminal narrowing of the dissected vessels. When patients present with acute flank pain, it is important to suspect renal infarction and to perform a correct diagnostic workup, even when the patient shows normal urinalysis results and a normal LDH value.

Fibromuscular dysplasia (FMD) is a vascular disease characterized by abnormal arterial wall architecture, usually visualized angiographically as the classic “string of beads” sign. We present the diagnostic dilemma of a 51-year-old woman admitted for a spontaneous renal infarct, with initial examination and investigations equivocal. She was consequently assessed for thromboembolic and vasculitic disease, before proceeding to digital subtraction angiography (DSA). This invasive method elucidated an area of focal FMD, previously not seen on computed tomography angiography (CTA). This is unusual due to CTA's high sensitivity and specificity but could be attributed to the less common subtype of FMD which requires combined imaging modalities to arrive at a diagnosis. Hence, there may be a role for the dual use of CTA and DSA in young patients presenting with a spontaneous renal infarct in the absence of other diagnoses.

Spontaneous renal artery dissection (SRAD) is a rare entity with less than 200 cases reported in literature. It usually affects middle-aged men and the clinical presentation is non-specific. Many times it is associated with conditions such as hypertension, fibromuscular dysplasia or vasculitides. We report the case of a patient who initially had renal infarct due to SRAD and then progressed to have bowel ischaemia. The renal infarct preceded bowel ischaemia in this patient and to the best of our knowledge this is the first such association reported in literature. Our report emphasises the point that whenever this condition is diagnosed in a patient one should be vigilant for other vascular disorders.

We present a case of spontaneous renal artery dissection (SRAD) in a 28-year-old female with history of neurofibromatosis type I (NF-1) treated successfully with endovascular stenting. The clinical presentation, diagnostic testing, and treatment options are discussed. An endovascular approach with stenting was successfully performed after failure of medical treatment with subcutaneous low molecular weight heparin. Patient’s blood pressure and symptoms improved significantly. This may be the first reported case of SRAD in a patient with NF-1 successfully treated with endovascular stenting.

We report an interesting case of a 65-year-old gentleman who presented with hypertensive emergency and was found to have an isolated spontaneous dissection of the right renal artery. The dissection was stented via endovascular approach and resulted in marked improvement in blood pressure. Spontaneous renal artery dissection is a difficult condition to diagnose and treat, unless suspected early enough during the course of treatment. Endovascular intervention is the treatment of choice, as failure of conservative treatment may have long lasting clinical implications relating to decreased renal perfusion. Surgical intervention can be associated with high rate of complications.

Background Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. Purpose To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. Material and Methods From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34–48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. Results Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. Conclusion Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.

We present a case of bilateral renal artery dissection, with the related computed tomographic images, caused by blunt torso trauma. Discussion includes the etiologies of this type of injury, the diagnostic modalities, and treatment options.