Tamakloe Comfort S, Davey Conner, Dorn Kaitlyn, Gilbert Patrick, Williams Frank B
The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
Department of Urology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2025 Spring;25(1):59-63. doi: 10.31486/toj.24.0062.
A renal arteriovenous fistula (RAVF) is an abnormal connection between the artery and vein of the kidney and can result from idiopathic, congenital, or traumatic causes. In the general population, this pathology is rare and has the potential to be life-threatening. The incidence in pregnancy is even rarer.
A pregnant 33-year-old gravida 5, para 4 patient presented with gross hematuria and passage of clots and was diagnosed with a right renal lower pole arteriovenous fistula at 36 weeks, 6 days' gestation. The patient developed gestational hypertension but did not demonstrate severe features of preeclampsia She underwent labor induction, uncomplicated spontaneous vaginal delivery, and subsequent endovascular embolization of the fistula. Hematuria and hypertension resolved postembolization.
Because RAVF presents with nonspecific symptoms that mimic other causes of hematuria and hypertension in pregnancy, this rare vascular anomaly poses challenges in diagnosis and management in pregnant patients. Our case was also challenging because of the late-stage pregnancy diagnosis. The case highlights the challenges of diagnosing and managing RAVF during pregnancy and underscores the importance of a multidisciplinary approach.
肾动静脉瘘（RAVF）是肾脏动脉与静脉之间的异常连接，可由特发性、先天性或创伤性原因引起。在普通人群中，这种病理情况罕见，且有可能危及生命。在妊娠期的发病率甚至更低。
一名33岁、孕5产4的孕妇，在妊娠36周6天时出现肉眼血尿和血凝块排出，被诊断为右肾下极动静脉瘘。该患者出现妊娠期高血压，但未表现出子痫前期的严重特征。她接受了引产，顺产过程顺利，随后对瘘管进行了血管内栓塞治疗。栓塞治疗后血尿和高血压症状消失。
由于RAVF表现出的非特异性症状与妊娠期其他血尿和高血压病因相似，这种罕见的血管异常给妊娠患者的诊断和管理带来了挑战。我们的病例由于在妊娠晚期诊断，也具有挑战性。该病例突出了妊娠期RAVF诊断和管理的挑战，并强调了多学科方法的重要性。
