Bilateral renal artery occlusion in a patient with progressive systemic sclerosis

A patient with renal failure due to progressive systemic sclerosis showed bilateral renal artery occlusion on renal angiography. The mechanism for the involvement of the main renal arteries is unknown, but it is postulated that the involvement of the main stem renal arteries was an extension of the pre-existing occlusive process in the interlobular arteries. This was hastened by the severe reduction in renal blood flow due to the hemorrhage and sepsis complicating the course. Another possible mechanism is a reduction of the fibrinolytic activity in the region of the intimal narrowing of the renal artery, coupled with reduction of the blood flow. The kidney biopsy showed intimal thickening and almost complete occlusion of interlobar arteries. Similar changes were observed in the smaller arteries. These findings are consistent with scleroderma of the kidney.