Renal Artery Thrombosis May 5, 2009

Outline Etiology Clinical Manifestations Differential Diagnosis Diagnosis Treatment Prognosis

Etiology The most common cause of renal artery thrombosis is thromboembolic occlusion. Atrial fibrillation – left atrial thrombus Septic or aseptic valvular vegetations Paradoxical emboli Tumor emboli

Etiology In situ thrombosis does occur, but less commonly Complication of progressive atherosclerosis in elderly patients Traumatic thrombosis – blunt trauma or deceleration injuries Inflammatory disorders or hypercoagulable states

Clinical Manifestations Sudden onset abdominal or flank pain Fever Nausea, vomiting Hematuria Acute onset hypertension

Laboratory Findings Elevated serum transaminases Elevated LDH Urinary lactate dehydrogenase Urinalysis – microscopic hematuria Elevated BUN and creatinine Elevated wbc count

Differential Diagnosis Pyelonephritis Renal colic Mesenteric ischemia Cholecystitis Pancreatitis

Diagnosis Renal arteriography CT scan MRA Duplex ultrasound

Treatment Antihypertensive treatment Thrombolysis/Thrombectomy Anti-coagulation Surgery

Prognosis Based on associated morbidity of patients

References Goldman, Lee et al. Cecil Textbook of Medicine. Philadephia: Saunders, “Renal Artery Thrombosi.” UptoDate