Renal Arteriovenous Fistula Presenting as Heart Failure

Renal arteriovenous fistula is a rare condition. The clinical presentations include gross hematuria, hypertension, high output heart failure and flank bruit. Interventional therapy includes observational treatment, partial or total nephrectomy, endovascular embolization and insertion of a covered stent. We present the case of a 70-year-old woman who presented with heart failure symptoms of 2 years' duration prior to admission. On presentation, she had evidence of congestive heart failure, pulmonary hypertension and increased cardiac output. Subsequent investigations led to the diagnosis of left renal arteriovenous fistula. While she opted for conservative treatment, the various therapeutic options of this uncommon condition are addressed.