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Management of Spontaneous Renal Arteriovenous Fistula in Pregnancy
Comfort S Tamakloe1, Conner Davey2, Kaitlyn Dorn1,3
1The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
Background:
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.
Case Report:
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.
Conclusion:
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.
