Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case / 中国医学科学院学报

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.

A case of recurrent flash pulmonary edema after renal artery bypass graft in renal artery stenosis / 대한내과학회지

Renal artery stenosis is a rare cause of acute pulmonary edema. So-called flash pulmonary edema is associated with bilateral renal artery stenosis or stenosis in a single functioning kidney. Flash pulmonary edema has been recognized as an absolute indication for vascular intervention. A 33-year old man was admitted with acute shortness of breath. Renal angiography showed occlusion of the right renal artery. He underwent a right renal artery bypass graft. However, after the renal artery bypass graft, episodes of pulmonary edema recurred. A renal angiography showed complete obstruction of the right renal artery and bypass graft. The left renal angiography showed an intact renal artery and decreased kidney size.

Interventional therapy of atherosclerotic renal artery occlusion / 介入放射学杂志

Objective To investigate the effectiveness of interventional therapy for the atherosclerotic renal artery occlusion (ARAO). Methods During the period of June 2001-Dec. 2007, 16 patients with ARAO (total of 16 occluded arteries) underwent interventional managements, including percutaneous endovascular renal artery revascularization, balloon dilatation angioplasty and stent placement. Follow-up survey was made at regular intervals. The patent condition of the renal artery was evaluated with ultrasonography and digital subtraction angiography. The blood pressure and the renal function were determined and the data were statistically analyzed in order to assess the intermediate and long-term effect of the interventional therapy. Results Of 16 patients, technical success was achieved in 15 (93.8%) and failure occurred in one. During a follow-up period of 9 - 24 months, 3 patients died. According to the data obtained at each patient’s last follow-up survey, the hypertension fell to normal in 3 (25.0%), was improved in 7 (58.3%) and showed no marked change in 2 patients (16.7%), with a clinical efficacy of 83.3% (10 / 12). The renal function was improved in 2 (16.7%), stabilized in 6 (50%) and deteriorated in 4 patients (33.3%), with an effective rate of 66.7% (8 / 12). Conclusion For the treatment of atherosclerotic renal artery occlusion, the interventional therapy carries high successful rate and can effectively lower the blood pressure level, in addition, it can also protect the renal function in a certain degree.

A Case of Acute Myocardial Infarction and Multiorgan Involvement Secondary to Rheumatoid Vasculitis

Rheumatoid arthritis patients have an increased risk of subclinical cardiovascular disease, and they also have a high prevalence of carotid disease and peripheral arterial disease as a form of vasculitis. Rheumatoid arthritis patients have an increased cardiovascular mortality rate and an increased premature death rate, and they have a higher incidence of atherosclerosis. Myocardial infarction due to vasculitis is a rare complication for patients with rheumatoid vasculitis. We report here on a case of a patient with multiorgan involvement who developed myocardial infarction, right carotid artery occlusion and left renal artery occlusion secondary to his rheumatoid vasculitis.

Stenting for Bilateral Renal Artery Occlusion with a Distal Embolic Protection Device / 대한신장학회잡지

Renal artery disease is one of the significant factors that lead to compromise renal function and/or aggravate hypertension in the elderly population. Since the non-surgical treatment of renal artery stenosis, percutaneous transluminal renal angioplasty, is available, it is possible to cure the decreased renal function and exacerbated hypertension. However, bilateral renal artery occlusion (BRAO) that brings about anuria and azotemia is rare. In this communication, we'd like to describe a patient who developed acute renal failure due to BRAO. His renal function was completely recovered after successful implantation of stents into both renal arteries. We are unaware of prior reports documenting the beneficial effect of a distal embolic protection device, the PercuSurge GuardWire system (Medtronic, Minneapolis, MN, USA), in a clinical setting as described here. The GuardWire arm, a device for transient distal balloon occlusion during angioplasty or stent placement, allows recovery of any liberated plaque by aspiration before restoration of antegrade flow, and thereby performs a double service. We'd like to strongly recommend that stent implantation with adjunctive distal protection is essential to obtain a complete restoration of distal blood flow although there is sufficient collateral blood flow in elderly patients with BRAO and azotemia.

Asynchronous Bilateral Renal Infarction with Atrial Fibrillation Korea

Acute renal infarction is an uncommon disease which is often delayed or missed due to its rarity and unspecific clinical presentations. Most patients have an underlying disease or embolic event that can be detected easily by history and physical examination. The frequently noted symptoms include flank, abdominal, and back pain, as well as nausea. The pain is usually acute, severe, and sharp in nature without radiation. The most sensitive laboratory test is lactate dehydrogenase. Angiography, renal scintigraphy, IVP (intravenous pyelography), sonography and, CT (computed tomography) can be used in diagnosing renal infarction. However, CT is more preferred for the diagnosis of renal infarction because it has the advantages of easy accessability and noninvasiveness. Once diagnosed, conservative treatment with intra-arterial infusion of thrombolytics or heparin appears to be the most favorable modality. We report a 82-year-old male with asynchronous bilateral renal infarctions associated with atrial fibrillation and coronary artery disease. His clinical status improved during admission without any events.