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Mohammed Elhassan, Shaikh Husnain, Raza Mian Department of Internal Medicine, Division of Hospital Medicine, University of California San Francisco (UCSF) Fresno Medical Education Program, Fresno, CA, USA Abstract: 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. Keywords: spontaneous renal artery dissection, renal infarction, sexual intercourse

Isolated spontaneous renal artery dissection (RAD) without known trauma is rare, and its etiology has not been determined. However, notable risk factors including hypertension, strenuous exercise, connective tissue disorders, atherosclerosis, extracorporeal shock wave lithotripsy, and cocaine abuse have been reported. To the best of our knowledge, isolated RAD caused by lumbar vertebra osteophytes in patients with degenerative lumbar scoliosis has not been reported in the literature. In this article, we present a case of RAD caused by lumbar vertebra osteophyte in a patient with degenerative scoliosis and discuss the management of the disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Spontaneous renal artery dissection (SRAD) is rare. Clinical manifestations vary from minimal symptoms to life-threatening hypertension. We analysed three cases from our institution and conducted a literature review in order to design diagnostic and treatment algorithms for SRAD. Journal of Human Hypertension (2006) 20, 710–718. doi:10.1038/sj.jhh.1002045; published online 18 May 2006 [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Renal artery dissection is a rare cause of abdominal pain. The renal arteries are the commonest site of primary dissection involving visceral vessels but spontaneous bilateral dissection is extremely rare. Presentation of case: We present a case of spontaneous bilateral renal artery dissection in a previously fit 43-year-old man who presented with right iliac fossa pain. He was treated conservatively with anticoagulation for 6 months, with resolution of the dissections on imaging at 6-month follow-up. Discussion: The presentation of spontaneous renal artery dissection is non-specific, making it a diagnostic challenge. Computed Tomography angiography is now the gold standard for diagnosis and follow-up of these patients. Conclusion: This case highlights the importance of considering other causes of abdominal pain in a young man with normal initial investigations and the role of conservative management. [Copyright &y& Elsevier]

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.

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.

The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m² or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2017 The Korean Academy of Medical Sciences.)

Summary: Spontaneous renal artery dissection is a rare condition that precedes renal infarction. We describe a 48-year-old, normotensive healthy woman presenting with left flank pain of sudden onset. Enhanced abdominal computed tomography demonstrated a dissecting intimal flap of the left renal artery complicating renal infarction. Doppler ultrasonography, selective angiography, and intravascular ultrasound revealed a dissecting intimal flap, with a large false lumen and narrow true lumen, of the renal artery bilaterally. Conservative management was undertaken with anticoagulant and analgesic therapy, and the patient was discharged after an uneventful clinical course. [ABSTRACT FROM AUTHOR]

Spontaneous renal artery dissection (SRAD) is a relatively rare entity that has been described in several case reports and small series in the medical literature. The condition is best diagnosed with angiography, with renal ischemia or infarction a common complication. Conservative medical management, surgical intervention, and percutaneous intervention are all discussed in the current literature. However, there is no consensus on which treatment option provides the best clinical outcome. Percutaneous stent placement has only recently been considered as an option for treatment of SRAD. This case report reviews the course of an otherwise healthy patient with a solitary right kidney who had SRAD complicated by renal infarction and was treated by percutaneous renal artery stent placement. Subsequently, we discuss and review the literature on SRAD treatment.