[Renal artery embolism]

To report a case of renal artery embolism. To review the clinical, diagnostic and therapeutic features of this disease interesting for the urologist.

Case of a 47 year old male with history of cardiovascular disease who presents in the emergency room with left flank pain. Radiological studies (Intravenous pyelogram (IVP) and ultrasound) ruled out urinary tract obstruction and oriented to renal vascular disease. Arteriography was performed showing left renal artery embolism. Fibrinolytic therapy was successful.

Renal artery embolism is an unusual non traumatic vascular urologic emergency. Generally, it appears in patients with emboligenous heart diseases, mainly auricular fibrillation associated with mitral stenosis. More than half the cases are asymptomatic; if they have symptoms, the most common presentation is sudden onset of intense flank pain, resistive to analgesia. Laboratory tests show hematuria, pyuria, proteinuria, leucocytosis, increased LDH, GOT and alkaline phosphatase, and variable renal function impairment. An ultrasound showing no signs of obstructive uropathy and absent function in the IVP lead to diagnosis. In the case of early diagnosis, intra-arterial fibinolysis is the treatment of choice, leaving surgery for cases where renal function is in danger. Main complications are vasculorenal hypertension and renal failure.