Kantauskaite Marta, Grabitz Klaus, Rump Lars Christian, Potthoff Sebastian Alexander
Department of Nephrology, Heinrich-Heine University, Medical Faculty, University Clinic Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
Department of Vascular and Endovascular Surgery, Heinrich-Heine University, Medical Faculty, University Clinic Duesseldorf, Duesseldorf, Germany.
BMC Nephrol. 2025 Aug 1;26(1):427. doi: 10.1186/s12882-025-04352-4.
Renal infarction is an extremely rare condition occurring in the context of structural or functional cardiac abnormalities, renal artery injury or coagulative syndromes. Although the clinical presentation of renal infarction is often nonspecific, the presence of symptoms such as back pain, high blood pressure, nausea and fever should raise suspicion, particularly in the emergency setting. Timely diagnosis is crucial for preserving renal function, whether through minimally invasive procedures or bypass surgery.
We present a case of a young male who developed acute occlusion of an aortic-renal bypass supplying a solitary left kidney. The patient exhibited resistant arterial hypertension and acute oligo-anuric kidney injury requiring dialysis. Despite the total occlusion of the aorto-renal bypass on imaging, doppler ultrasound demonstrated moderate renal tissue perfusion, likely maintained via collateral vasculature. The existence of a previous prolonged ischemic condition may have led to the formation of collateral-dependent circulation. While insufficient for pressure-dependent diuresis, the collateral flow preserved renal tissue oxygenation.
Collateral perfusion should be evaluated in cases of renal infarction, particularly when the main renal artery is occluded. Adequate collateral circulation might preserve renal tissue viability beyond the typical ischemic window.
肾梗死是一种极为罕见的病症，发生于结构性或功能性心脏异常、肾动脉损伤或凝血综合征的背景下。尽管肾梗死的临床表现通常不具特异性，但背痛、高血压、恶心和发热等症状的出现应引起怀疑，尤其是在急诊情况下。及时诊断对于通过微创手术或搭桥手术保留肾功能至关重要。
我们报告一例年轻男性病例，其供应孤立左肾的主动脉 - 肾旁路发生急性闭塞。患者表现为顽固性动脉高血压和急性少尿 - 无尿性肾损伤，需要进行透析。尽管影像学显示主动脉 - 肾旁路完全闭塞，但多普勒超声显示肾组织有中度灌注，可能是通过侧支血管维持的。先前存在的长时间缺血状态可能导致了侧支依赖循环的形成。虽然侧支血流不足以实现压力依赖性利尿，但保留了肾组织的氧合。
在肾梗死病例中，尤其是主肾动脉闭塞时，应评估侧支灌注情况。充足的侧支循环可能在典型缺血窗之外维持肾组织的活力。
