Title: Atherogenic Induced Renal Artery Thrombosis
Authors: Karim Habbal MD and Agostino Ingraldi MD. Ocshner Lafayette General Medical Center
Introduction: Guidelines pertaining to the management of renal arterial thrombosis are limited given the absence of prospective randomized controlled trials 1 . Treatment strategies include percutaneous, surgical and medical approaches and are often determined on a case to case basis through clinical experience. Case Presentation: A 71-year-old male with past medical history of CAD, HTN, HLD, OSA, DM who presented with intermittent non-radiating left flank and left periumbilical pain. An Abdominal CT with contrast revealed left renal infarct. A renal artery angiogram demonstrated severe atherosclerotic left renal artery stenosis of 99% reduced to 0% following balloon angioplasty and stenting. There was extensive residual thrombus burden of the renal artery extending into the segmental and lobar branches (see Figure 1). Post intervention therapy included full dose Enoxaparin and Tirofiban drip for 24 hours in addition to Clopidogrel 75 mg and Aspirin 81 mg daily. The patient was discharged on 3-weeks of Rivaroxaban 15 mg BID and DAPT. A repeat left renal angiogram after 3- weeks of therapy revealed widely patent left renal anatomy with complete resolution of the previous thrombus (see Figure 1). Rivaroxaban was discontinued and DAPT continued. Discussion: Renal arterial infarction is a rare and frequently missed condition in patients presenting with flank pain. Most common causes include thromboembolisms from atrial fibrillation and cholesterol emboli. Complete renal arterial infarct is rare 1 . This patient’s hypertension improved from 205/91 to 126/69 following intervention. Renal function also improved following the intervention and returned to baseline stage 3 CKD. Conclusion: This case presents further insight to the management of renal arterial thrombosis, especially with regards to the utilization of triple therapy and its success in this patient.
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