Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study
Open Access
- 15 October 2019
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Nephrology
- Vol. 20 (1), 1-8
- https://doi.org/10.1186/s12882-019-1559-8
Abstract
Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries. We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries. He had AKI, which unexpectedly progressed to ESKD, without any radiological evidence of direct involvement of the renal arteries. Thus, we failed to attribute the ESKD to the dissection and hesitated to perform any surgical intervention. Nevertheless, the patient’s hormonal levels, fractional excretion values, ankle brachial indices, and Doppler resistive indices seemed to indirectly suggest kidney malperfusion and implied renal artery hypo-perfusion. However, abdominal computed tomography imaging only revealed progressive thrombotic obstruction of the false lumen and compression of the true lumen in the descending thoracic aorta, despite the absence of anatomical blockage of renal artery perfusion. Later, signs of peripheral malperfusion, such as intermittent claudication, necessitated surgical intervention; a graft replacement of the aorta was performed. Post-operatively, the patient completely recovered after 3 months of haemodialysis, and the markers that had pre-operatively suggested decreased renal bloodstream normalised with recovery of kidney function. To the best of our knowledge, this is the first report of severe AKI, secondary to aortic dissection, without direct renal artery obstruction, which progressed to “temporary” ESKD and was resolved following surgery. This case suggests that only coarctation above the renal artery branches following an aortic dissection can progress AKI to ESKD, despite the absence of radiological evidence confirming an obvious anatomical blockage. Further, indirect markers suggestive of decreased renal blood flow, such as ankle brachial indices, renal artery resistive indices, urinary excretion fractions, and hormonal changes, are useful for evaluating concomitant AKI and may indicate the need for surgical intervention after a Stanford type B aortic dissection.Keywords
This publication has 32 references indexed in Scilit:
- Acute Thoracic Aortic Dissection (Stanford Type B) Complicated with Acute Renal FailureCase Reports in Vascular Medicine, 2013
- Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysmBMC Nephrology, 2013
- Aortic Dissection and Renal Failure in a Patient with Severe HypothyroidismCase Reports in Medicine, 2012
- Acute Kidney Injury in Elderly PersonsAmerican Journal of Kidney Diseases, 2010
- Are plasma renin activity and aldosterone levels useful as a screening test to differentiate between unilateral and bilateral renal artery stenosis in hypertensive patients?Journal of Hypertension, 2010
- Surgical strategies for organ malperfusions in acute type B aortic dissectionInteractive CardioVascular and Thoracic Surgery, 2008
- Diagnostic Performance of Fractional Excretion of Urea and Fractional Excretion of Sodium in the Evaluations of Patients With Acute Kidney Injury With or Without Diuretic TreatmentAmerican Journal of Kidney Diseases, 2007
- Acute Aortic SyndromesCirculation, 2005
- Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)Journal of the American College of Cardiology, 2004
- Risk factors for aortic dissection: A necropsy study of 161 casesThe American Journal of Cardiology, 1984