Rupture of renal artery aneurysm during late pregnancy: clinical features and diagnosis

Rupture of renal artery aneurysm during pregnancy is a severe complication with high mortality and morbidity for mother and fetus, and diagnosis is difficult. The clinical presentation is easily confused with more common conditions like placental abruption, and most of the cases are diagnosed with timely delay.

We present the case of a patient with spontaneous rupture of an aneurysm of the left renal artery during late pregnancy and summarize the previous reports of ruptured renal artery aneurysm during pregnancy and early postpartum period.

Regarding all published cases up to now (n = 32), 65.6% of mothers and 40.6% of fetuses survived. The rupture occurred in 68.7% in the third trimester and in 6.3% shortly postpartum. In our case, the increase of maternal serum lactate in a hemodynamically stable patient lead to diagnosis.

Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with flank pain. Early diagnosis and immediate intervention are important for achieving better outcomes for mother and fetus. Careful surveillance and laboratory results like serum lactate may lead to diagnosis even in hemodynamically stable patients.