Renal Artery Thrombosis

Today, we reviewed a case of an elderly gentleman with a complicated PMH including TEVAR c/b paraplegia from cord ischemia who initially presented with acute nausea/vomiting, abdominal pain, hematuria and subjective fevers. Overnight, he became acutely hypertensive with progressive abdominal pain, prompting CT abdomen imaging which showed renal artery thrombosis.

Learning Points:

  • History and physical of renal artery thrombosis include acute onset flank or generalized abdominal pain, nausea, vomiting, fever, and possible acute elevation in blood pressure.
  • Dr. Liu discussed an article by Oh that found that the most common etiology was cardiogenic, followed by idiopathic, renal artery injury, and hypercoagulable state.
  • Labs include an elevated LDH, hematuria, and occasionally leukocytosis. Serum Cr is generally not markedly elevated at presentation.
  • Treatment includes anticoagulation, antihypertensive medications, and possibly thrombolysis/thromboectomy. Given how rare the diagnosis, there are no RCTs evaluating which treatment option is best. Our patient was anticoagulated, but did not undergo thromboectomy as his kidney was atrophied suggesting an acute on chronic presentation.