Unilateral renal atrophy associated with abdominal aortic aneurysm

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Kidney Res Clin Pract. 2017;36(4):394-395

Publication date (electronic) : 2017 December 31

doi : https://doi.org/10.23876/j.krcp.2017.36.4.394

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea

Correspondence: 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 2017 August 29; Accepted 2017 August 31.

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.

Figure 1

Computed tomographic angiography revealed an 8.5-cm abdominal aortic aneurysm (AAA) and an atrophic left kidney

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).

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.

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