Neto Nelson, Romero Joaquin Gil, Sanchis Juan Manuel, Guijarro Jorge, da Cruz Julio Palmero
Radiology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Radiology Department, Hospital Clínico Universitario de Valencia, Valence, Spain.
BJR Case Rep. 2016 May 17;2(2):20150366. doi: 10.1259/bjrcr.20150366. eCollection 2016.
Acute renal infarction occurs usually secondary to thromboembolism rather than thrombosis, with atrial fibrillation being the main predisposing factor. Its non-specific presentation, being similar to renal colic and pyelonephritis, often leads to diagnostic and treatment delays. Prompt diagnosis and treatment are crucial for the outcome, as the precise therapeutic window remains unclear. Renal Doppler ultrasound is the optimal initial diagnostic study, which, if inconclusive, should be followed by contrast-enhanced CT. Despite the lack of specific guidelines, treatment is mainly based on anticoagulation and percutaneous endovascular revascularization therapy; the latter includes pharmacomechanical thrombectomy; intra-arterial thrombolysis alone or in combination with thrombus aspiration; and angioplasty, with or without stenting. We present a case of renal thromboembolism diagnosed early during the postoperative period in a patient with a single functioning kidney. Renal arterial flow restoration was achieved by means of transcatheter thrombus aspiration. This is the first report showing the effectiveness of this procedure alone as an alternative to those used so far.
急性肾梗死通常继发于血栓栓塞而非血栓形成，心房颤动是主要的诱发因素。其表现不具特异性，与肾绞痛和肾盂肾炎相似，常导致诊断和治疗延误。由于确切的治疗窗口期尚不清楚，及时诊断和治疗对预后至关重要。肾多普勒超声是最佳的初始诊断检查，若结果不明确，应继以增强CT检查。尽管缺乏具体指南，但治疗主要基于抗凝和经皮血管内血运重建治疗；后者包括药物机械性血栓切除术、单独或联合血栓抽吸的动脉内溶栓，以及有或无支架置入的血管成形术。我们报告一例术后早期诊断为肾血栓栓塞的单功能肾患者。通过经导管血栓抽吸实现了肾动脉血流恢复。这是首份显示该操作单独作为迄今所用方法替代方案有效性的报告。
