Abstract
Thrombosis and renovascular hypertension are complications of umbilical artery catheters (UAC). There are no reported cases of resolution of bilateral renal artery thromobosis leading to complete renal failure. We report an infant with complete aortic occlusion. A 1.3 kg 30 week gestation male infant was delivered via cesearean section for pre-eclampsia. UAC and umbilical venous catheter (UVC) were placed. Respiratory distress was managed with CPAP and oxygen therapy. UAC was removed on day 5. Complete renal failure (max: BUN 40, Creat 4.2) and hypertension (systolic BP > 110 mmHg) presented on day 8; UVC was removed. Renal scan showed no perfusion; abdominal ultrasound demonstrated complete aortic thrombosis from the superior mesenteric artery to the iliac arteries and including both renal arteries. Renal failure was managed with peritoneal dialysis without complications. Hypertension was controlled with hydralazine (max. 4.6 mg/kg/24 hr), propranolol (max. 0.5 mg/kg/24 hr), alphamethyldopa (35 mg/kg/24 hr), and intermittent diazoxide (2.5 mg/kg/dose). Urine production resumed (0.6 cc/kg/hr) on day 22 and increased progressively without surgical or thrombolytic therapy. Renal function was markedly improved (BUN 3, Creat 1.4) at three months. Previous reports of management of renovascular hypertension have suggested revascularization, thrombectomy or thrombolysis. Management with invasive therapy must be carefully considered as supportive management of this infant resulted in resolution of arterial obstruction and return of reasonable renal function.
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Malin, S., Baumgart, S. & Foreman, J. BILATERAL RENAL ARTERY AND TOTAL AORTIC THROMBOSIS: SUCCESSUL NON-SURGICAL MANAGEMENT. Pediatr Res 18 (Suppl 4), 333 (1984). https://doi.org/10.1203/00006450-198404001-01441
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DOI: https://doi.org/10.1203/00006450-198404001-01441