Kidney Research and Clinical Practice 2017 Dec; 36(4): 394-395  https://doi.org/10.23876/j.krcp.2017.36.4.394
Unilateral renal atrophy associated with abdominal aortic aneurysm
Eun Hui Bae, Seong Kwon Ma, and Soo Wan Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Soo Wan Kim, Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. E-mail: skimw@chonnam.ac.kr. ORCID: http://orcid.org/0000-0002-3540-9004
Received: August 29, 2017; Accepted: August 31, 2017; Published online: December 31, 2017.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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A 78-year-old woman with hypertension presented with left flank pain. She had been taking angiotensin receptor blockers and beta blockers for the past six years. Her blood pressure was 140/90 mmHg, pulse rate 76/min, hemoglobin 12.3 g/dL (reference range, 12–18 g/dL), and creatinine level 0.5 mg/dL (reference range, 0.5–1.3 mg/dL). Urinalysis revealed microscopic hematuria and no proteinuria. A palpable abdominal mass was detected and pulsation could be felt. Abdominal computed tomographic angiography showed a thrombosed abdominal aortic aneurysm (AAA) with a maximum diameter of 8.5 cm and an atrophic left kidney. The right renal artery originated from the true lumen of the AAA (Fig. 1A), while the left renal artery originated from the false lumen and was smaller and more linear compared to the right renal artery (Fig. 1B). The patient and family refused surgical treatment of the AAA. The left flank pain was caused by herpes zoster, and the patient was discharged after treatment.

AAA refers to a localized, abnormal dilatation of the aorta to a diameter > 3 cm or 50% of the aortic diameter at the diaphragm. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture. Endovascular repair of AAAs has widely replaced open surgical repair due to its minimally invasive nature and accompanying lower perioperative mortality and morbidity. However, its application is impossible in AAAs involving the renal arteries.

Renal artery clipping induces unilateral renal artery atrophy in the murine two-kidney one-clip model. We report a clinically similar case of AAA involving the renal arteries.

Figures
Fig. 1. The arrows indicate that the right renal artery originates from the true lumen of the AAA (A), while the left renal artery originates from the false lumen. The left renal artery is smaller and more linear compared to the right renal artery (B).


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