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Spontaneous renal artery dissection: three cases and clinical algorithms

Abstract

Spontaneous renal artery dissection (SRAD) is rare. Clinical manifestations vary from minimal symptoms to life-threatening hypertension. We analysed three cases from our institution and conducted a literature review in order to design diagnostic and treatment algorithms for SRAD.

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References

  1. Banitt PF, Clark CW . Isolated dissecting aneurysm of the renal artery. J Urol 1986; 135: 998–999.

    CAS  Article  Google Scholar 

  2. Beroniade V, Roy P, Froment D, Pison C . Primary renal artery dissection. Presentation of two cases and brief review of the literature. Am J Nephrol 1987; 7: 382–389.

    CAS  Article  Google Scholar 

  3. Gewertz BL, Stanley JC, Fry WJ . Renal artery dissections. Arch Surg 1977; 112: 409–414.

    CAS  Article  Google Scholar 

  4. Bumpus HC Jr . A case of renal hypertension. J Urol 1944; 52: 295–299.

    Article  Google Scholar 

  5. Liebow IM, Cline T, Post RS, Persky L . Isolated bilateral simultaneous dissection of the renal arteries. Am J Med 1956; 21: 151.

    CAS  Article  Google Scholar 

  6. Martin X, Salas M, Bouvier R, Ninet J, Gelet A, Dubernard JM . Extracorporeal repair of primary renal artery dissection. Eur Urol 1993; 24: 424–427.

    CAS  Article  Google Scholar 

  7. Boughey JC, Gifford RR, Collins JB . Spontaneous renal artery dissection in a healthy man. J S C Med Assoc 2001; 97: 246–249.

    CAS  PubMed  Google Scholar 

  8. Alamir A, Middendorf DF, Baker P, Nahman Jr NS, Fontaine AB, Hebert LA . Renal artery dissection causing renal infarction in otherwise healthy men. Am J Kidney Dis 1997; 30: 851–855.

    CAS  Article  Google Scholar 

  9. Slavis SA, Hodge EE, Novick AC, Maatman T . Surgical treatment for isolated dissection of the renal artery. J Urol 1990; 144: 233–237.

    CAS  Article  Google Scholar 

  10. Rao CN, Blaivas JG . Primary renal artery dissecting aneurysm: a review. J Urol 1977; 118: 716–719.

    CAS  Article  Google Scholar 

  11. Muller BT, Reiher L, Pfeiffer T, Muller W, Hort W, Voiculescu A et al. Surgical treatment of renal artery dissection in 25 patients: indications and results. J Vasc Surg 2003; 37: 761–768.

    Article  Google Scholar 

  12. Ramamoorthy SL, Vasquez JC, Taft PM, McGinn RF, Hye RJ . Nonoperative management of acute spontaneous renal artery dissection. Ann Vasc Surg 2002; 16: 157–162.

    Article  Google Scholar 

  13. Dobrilovic N, Bennett S, Smith C, Edwards J, Luchette FA . Traumatic renal artery dissection identified with dynamic helical computed tomography. J Vasc Surg 2001; 34: 562–564.

    CAS  Article  Google Scholar 

  14. Hasday JD, Sterns RH, Karch FE . Renal infarction due to renal artery dysplasia with dissection. Report of a case in a normotensive patient. Am J Med 1984; 76: 943–946.

    CAS  Article  Google Scholar 

  15. Lacombe M . Isolated spontaneous dissection of the renal artery. J Vasc Surg 2001; 33: 385–391.

    CAS  Article  Google Scholar 

  16. Bilge AK, Nisanci Y, Yilmaz E, Ozben B, Oncul A, Mercanoglu F et al. Renovascular hypertension secondary to spontaneous renal artery dissection and treatment with stenting. Int J Clin Pract 2003; 57: 435–436.

    CAS  PubMed  Google Scholar 

  17. Englund GW . Primary dissecting aneurysm of the renal artery: report of a case and review of the literature. Am J Clin Pathol 1966; 45: 472–479.

    CAS  Article  Google Scholar 

  18. Watson AJ . Dissecting aneurysms of arteries other than the aorta. J Pathol Bact 1956; 72: 439–449.

    Article  Google Scholar 

  19. Henry L, Burke WD . Isolated dissecting aneurysm of the renal artery. Angiology 1963; 14: 269–276.

    CAS  Article  Google Scholar 

  20. Rosenblum WI . Isolated dissecting aneurysm of the renal artery. J Urol 1966; 95: 135–138.

    CAS  Article  Google Scholar 

  21. Smith BM, Holcomb III GW, Richie RE, Dean RH . Renal artery dissection. Ann Surg 1984; 200: 134–146.

    CAS  Article  Google Scholar 

  22. Fields E, Stawicki SP, Balshi JD . Spontaneous renal artery dissection: a systematic approach to diagnosis and treatment. Am J Hypertens Suppl 2004; 17: 236A.

    Article  Google Scholar 

  23. Nikulin A, Markovic B . Primary dissecting aneurysms of an interlobar renal arterty. Med Arch 1975; 29: 609–612.

    CAS  Google Scholar 

  24. Waron M, Gil I, Fogelfield L . Massive hematuria due to renal artery aneurysm. Harefuah 1983; 104: 92–94.

    CAS  PubMed  Google Scholar 

  25. Edwards BS, Stanson AW, Holley KE, Sheps SG . Isolated renal artery dissection, presentation, evaluation, management, and pathology. Mayo Clin Proc 1982; 57: 564–571.

    CAS  PubMed  Google Scholar 

  26. Mori H, Hayashi K, Tasaki T, Hori T, Yamasaki T, Amamoto Y . Spontaneous resolution of bilateral renal artery dissection: a case report. J Urol 1986; 135: 114–116.

    CAS  Article  Google Scholar 

  27. Reilly LM, Cunningham CG, Maggisano R, Ehrenfeld WK, Stoney RJ . The role of arterial reconstruction in spontaneous renal artery dissection. J Vasc Surg 1991; 14: 468–477.

    CAS  Article  Google Scholar 

  28. van Rooden CJ, van Baalen JM, van Bockel JH . Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation. J Vasc Surg 2003; 38: 116–122.

    Article  Google Scholar 

  29. Hare WS, Kincaid-Smith P . Dissecting aneurysm of the renal artery. Radiology 1970; 97: 255.

    CAS  Article  Google Scholar 

  30. Paul M, Bear RA . Dissecting aneurysm of renal artery. Reversible cause of high-renin hypertension. Urology 1984; 24: 483–484.

    CAS  Article  Google Scholar 

  31. Eiberg JP, Lundorf E, Thomsen C, Schroeder TV . Peripheral vascular surgery and magnetic resonance arteriography – a review. Eur J Vasc Endovasc Surg 2001; 22: 396–402.

    CAS  Article  Google Scholar 

  32. Hanninen EL, Denecke T, Stelter L, Pech M, Podrabsky P, Pratschke J et al. Preoperative evaluation of living kidney donors using multirow detector computed tomography: comparison with digital subtraction angiography and intraoperative findings. Transplant Int 2005; 18: 1134–1141.

    Article  Google Scholar 

  33. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.

    CAS  Article  Google Scholar 

  34. August P . Initial treatment of hypertension. N Engl J Med 2003; 348: 610–617.

    Article  Google Scholar 

  35. Losito A, Errico R, Santirosi P, Lupattelli T, Scalera GB, Lupattelli L . Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition. Nephrol Dial Transplant 2005; 20: 1604–1609.

    CAS  Article  Google Scholar 

  36. Yang JG, Hu D, Li T, Peng J, Yu H, Pang W et al. Angiotensin-converting enzyme inhibitor usage in patients with incidental atherosclerotic renal artery stenosis. Hypertens Res 2004; 27: 339–344.

    CAS  Article  Google Scholar 

  37. Ahmed A . Use of angiotensin-converting enzyme inhibitors in patients with heart failure and renal insufficiency: how concerned should we be by the rise in serum creatinine? J Am Geriatr Soc 2002; 50: 1297–1300.

    Article  Google Scholar 

  38. Heim P, Fernandez S, Nicholas V . Spontaneous renal artery dissection. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1997; 167: 652–654.

    CAS  Article  Google Scholar 

  39. Damaraju S, Krajcer Z . Successful Wallstent implantation for extensive iatrogenic renal artery dissection in a patient with fibromuscular dysplasia. J Endovasc Surg 1999; 6: 297–300.

    CAS  Article  Google Scholar 

  40. Mudrick D, Arepally A, Geschwind JF, Ronsivalle JA, Lund GB, Scheel P . Spontaneous renal artery dissection: treatment with coil embolization. J Vasc Interv Radiol 2003; 14: 497–500.

    Article  Google Scholar 

  41. Mokri B, Stanson AW, Houser OW . Spontaneous dissection of renal arteries in a patient with previous spontaneous dissections of the internal carotid arteries. Stroke 1985; 16: 959–963.

    CAS  Article  Google Scholar 

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Correspondence to S P Stawicki.

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Stawicki, S., Rosenfeld, J., Weger, N. et al. Spontaneous renal artery dissection: three cases and clinical algorithms. J Hum Hypertens 20, 710–718 (2006). https://doi.org/10.1038/sj.jhh.1002045

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  • DOI: https://doi.org/10.1038/sj.jhh.1002045

Keywords

  • spontaneous renal artery dissection
  • diagnostic algorithm
  • treatment algorithm
  • systematic review
  • case reports
  • non-operative management

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