Renal Artery Embolism – Review of the Literature

Overview

Renal artery embolism (RAE) is a rare disease. Urgent treatment is necessary, as ischaemia can cause irreversiblekidney damage in 60 to 90 minutes. RAE frequently clinically manifests as a pain similar to renal colic. Source ofembolus is predominantly the heart at atrial fibrillation. Laboratory findings are unspecific. Ultrasonography withcolor Doppler imaging is essential. Kidney perfusion is low and upper urinary tract is undilated. Renal afunctioncan be recognized by intravenous urography and at renal scintigraphy. In angiography, renal artery is closed withthromboembolus. With no delay, transcatheter clot aspiration should be performed and fibrinolytic agents (tissueplasminogen activator) should be topically administered. Continual heparinisation and later warfarinisation shouldfollow. In spite of successful revascularisation, parameters of kidney function can almost never reach that prior theRAE and shrinkage of kidney becomes a frequent consequence. Treatment can be successful even in patients withrenal occlusion lasting over 90 minutes, since occlusion is often incomplete or significant collateral blood supplyexists. In conclusion, renal artery embolism must be considered in cases of flank pain in patients with certain riskactors (especially atrial fibrillation). Ultrasonography with color Doppler imaging and urgent angiography of therenal artery are necessary in these cases. Thromboembolus can be then aspirated, and kidney perfusedwith fibrinolyticagent.

Key words:
renal colic, renal artery embolism, ultrasonography, angiography fibrinolytic agents.