Farley Ned, Faraj Joseph, Fernando Malindu, Singh Tejas, Powell Aaron, Kumar Senthil
Department of Vascular Surgery, John Hunter Hospital, New Lambton Heights, NSW, Australia.
Vascular. 2025 Jun;33(3):613-616. doi: 10.1177/17085381241247906. Epub 2024 Apr 26.
BackgroundRenal artery thrombosis is rare and limited reports exist in the young population. The most common aetiology is thromboembolic disease or abdominal trauma in this population and isolated occurrences are extremely rare. We present the case of an 18-year-old woman with spontaneous unilateral renal artery thrombosis and infarction for whom reperfusion was achieved through endovascular intervention. The aetiology of her thrombosis remains unclear and is under investigation with differential diagnoses being fibromuscular dysplasia, large and medium vessel vasculitis, and thromboembolic causes.ObjectiveTo demonstrate the value in attempting salvage of an ischaemic kidney in a young patient with an unexplained spontaneous renal thrombosis.MethodJM is an 18-year-old woman who presented to a large regional tertiary hospital with 3 days of right flank pain. She had no infective symptoms and no urinary or bowel changes before admission. She was not pregnant, and her only medication was the oral contraceptive pill commenced 3 months prior. A CT angiogram demonstrated right renal artery thrombosis with renal infarction. The kidney was deemed potentially salvageable, and ultrasound defined adequate vessel calibre to access for thrombectomy in the context of a negative coagulopathy screen.ResultsThe patient underwent thrombolysis, thrombectomy and balloon angioplasty. Intraoperatively, a thin segment of distal stenosis was identified, and angiogram reperfusion was achieved with subsequent improvement in renal function.ConclusionRenal artery thrombosis in young people is extremely rare and presents a diagnostic and management challenge requiring input from multiple teams including nephrology, rheumatology, paediatrics and vascular surgery. Systemic coagulopathy and vasculitis are differentials against anatomical aetiologies such as fibromuscular dysplasia. Our case adds to the limited literature regarding this in the young population. Renal artery thrombosis with occlusion in young people is very rare and is most often associated with a systemic coagulopathic disorder, such as antiphospholipid syndrome or structural pathology of the renal vasculature such as fibromuscular dysplasia. The work-up of a young female presenting with renal artery thrombosis without any previous medical history screens for a wide range of pathological processes.
背景
肾动脉血栓形成较为罕见，关于年轻人群的相关报道有限。该人群中最常见的病因是血栓栓塞性疾病或腹部创伤，孤立发生的情况极为罕见。我们报告一例18岁女性自发性单侧肾动脉血栓形成并梗死的病例，通过血管内介入治疗实现了再灌注。其血栓形成的病因仍不清楚，正在进行调查，鉴别诊断包括纤维肌发育不良、大中血管血管炎和血栓栓塞原因。
目的
证明对于一名患有不明原因自发性肾血栓形成的年轻患者，尝试挽救缺血性肾脏的价值。
方法
JM是一名18岁女性，因右侧腰痛3天就诊于一家大型地区三级医院。她在入院前没有感染症状，也没有泌尿或肠道改变。她未怀孕，仅在3个月前开始服用口服避孕药。CT血管造影显示右肾动脉血栓形成伴肾梗死。该肾脏被认为有潜在挽救可能，超声显示在凝血功能检查阴性的情况下，血管管径足以进行血栓切除术。
结果
患者接受了溶栓、血栓切除术和球囊血管成形术。术中发现一小段远端狭窄，血管造影显示再灌注成功，肾功能随后得到改善。
结论
年轻人肾动脉血栓形成极为罕见，带来了诊断和管理挑战，需要多个团队（包括肾病科、风湿科、儿科和血管外科）的参与。全身性凝血障碍和血管炎是与纤维肌发育不良等解剖学病因相鉴别的疾病。我们的病例增加了关于年轻人群中这一情况的有限文献。年轻人肾动脉血栓形成伴闭塞非常罕见，最常与全身性凝血障碍性疾病（如抗磷脂综合征）或肾血管结构病变（如纤维肌发育不良）相关。对一名无既往病史的年轻女性出现肾动脉血栓形成的检查需筛查多种病理过程。
