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双侧主动脉-髂动脉支架血栓形成后的急性肾梗死

Acute Renal Infarction After a Bilateral Aortic-Iliac Stent Thrombosis.

作者信息

Chambino Beatriz, Gouveia Cláudio, Camacho Cristiana, Dionisio Antony, Ribeiro Ana Margarida, Henriques Célia

机构信息

Internal Medicine, Hospital São Francisco Xavier, Lisbon, PRT.

Internal Medicine, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT.

出版信息

Cureus. 2024 Jan 30;16(1):e53211. doi: 10.7759/cureus.53211. eCollection 2024 Jan.

Abstract

A renal infarction occurs when kidney's arterial blood supply is compromised, causing parenchymal necrosis and loss of function. It is a relatively uncommon complication and its treatment is time-dependent. We present a case where a female patient with a history of bilateral aortic-iliac stenting over 10 years before presented with chest pain, palpitations, and dyspnea associated with hypertension. The patient progressed with an acute worsening of renal function and anuria, with an urgent need for renal replacement therapy. The abdominal CT angiography confirmed a complete chronic stent thrombosis and a recent occlusion of the right renal artery causing an acute renal infarction; however, this exam was performed more than 72 hours after admission. There was no longer indication for reperfusion therapy, taking into account the time course. This case reinforces the importance of a thorough clinical history and awareness of risk factors to raise the suspicion of renal infarction that should lead to an early contrast-enhanced CT scan so that adequate therapy can be performed.

摘要

肾梗死是指肾脏的动脉血液供应受到损害,导致实质坏死和功能丧失。它是一种相对罕见的并发症,其治疗具有时间依赖性。我们报告一例病例,一名女性患者,10多年前有双侧主动脉-髂动脉支架置入史,出现胸痛、心悸和与高血压相关的呼吸困难。患者肾功能急性恶化并出现无尿,急需肾脏替代治疗。腹部CT血管造影证实存在完全性慢性支架血栓形成以及近期右肾动脉闭塞导致急性肾梗死;然而,该检查在入院72小时后进行。考虑到时间进程,不再有再灌注治疗的指征。该病例强化了全面临床病史和对危险因素的认识的重要性,以提高对肾梗死的怀疑,从而应尽早进行对比增强CT扫描,以便能够进行充分的治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f073/10902749/f19200af7b16/cureus-0016-00000053211-i01.jpg

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