Mitral stenosis complicated by renal artery embolism

Six patients with mitral stenosis complicated by renal artery embolism studied prospectively are presented. In five patients there was unilateral and in one patient bilateral renal artery involvement. The diagnosis was confirmed by intravenous pyelography, retrograde pyelography, renal angiography, renal scan or a combination of these. All had atrial fibrillation, proteinuria and elevated LDH levels. Two had developed hypertension at the initial presentation. All patients were treated with anticoagulants and other supportive measures. One developed reversible acute renal failure and the others had an uneventful hospital course. Subsequent I.V.P. and scans revealed nonfunctioning shrunken kidney in just one patient with complete obstruction of the main renal artery. We conclude that anticoagulation is an adequate substitute to embolectomy. The main role of surgery is in occasional patients who remain anuric despite medical therapy and in those whose angiography reveals complete occlusion of the main renal artery