Multiple Renal Infarctions in Spontaneous Double Renal Artery Dissection: A Case Report

Area of Science:

• Nephrology
• Vascular Surgery
• Radiology

Background:

• Spontaneous renal artery dissection (SRAD) is a rare cause of abdominal pain, with bilateral cases being exceptionally uncommon.
• Diagnosis is frequently delayed due to non-specific symptoms mimicking other conditions and the rarity of SRAD.
• Advanced imaging like CTA and MRA have improved diagnostic rates, including incidental findings.

Observation:

• Laboratory tests and radiological imaging revealed bilateral renal artery dissection.
• Multiple renal infarctions and ischemic areas were observed in both kidneys.
• The left renal artery showed intimal thickening and arteritis.

Findings:

• Multiplanar reconstruction confirmed bilateral renal artery dissection and widespread arterial infarctions.
• The patient was managed with dual antiplatelet therapy and ACE inhibitors following hypertension retargeting.
• No lipid-lowering therapy was required for this patient.

Implications:

• SRAD presents with varied symptoms and can be misdiagnosed, necessitating high clinical suspicion.
• Enhanced CT scans and vascular multiplanar reconstruction are crucial for accurate SRAD diagnosis.
• Despite over 300 reported cases, treatment consensus for SRAD remains elusive, with options including conservative management, open surgery, or endovascular intervention.