The patient was a 50-year-old man with a history of mitral valve disease secondary to rheumatic fever, treated with anticoagulants for atrial fibrillation, leukthyroxine, and stenosis.
She had a history of iatrogenic hypothyroidism (total thyroidectomy for papillary carcinoma).
She was admitted to the emergency room due to persistent clinical symptoms, characterized by sudden and continuous intense pain in the left iliac fossa without irradiation or analgesic position, accompanied by nausea and vomiting, with approximately 11 hours of evolution.
No other complaints.
No macroscopic hematuria.
On physical examination, the patient was conscious and oriented.
Ta 37.7oC, T.A 160 / 95 mm Hg, arrhythmic pulse, ±100 bpm.
Cardiac arrest indicating diastolic murmur II/VI located at the base foci.
Abdomen blando, painful to deep fixation in the left iliac fossa, with no signs of peritoneal irritation.
Abdominal fracture with decreased intestinal sounds, normal timbre.
Upper and lower limbs without perfusion deficit.
Neurological examination showed no abnormalities.
The analytical study revealed an Hb of 10.9 g/dL, Leuc 15.800/μL, Neut 85%, Creat 1.2 mg/dL, GDT and GPT of approximately 1.5 times higher than the reference values, INR.
Urine analysis revealed hematuria and proteinuria of 0.3 g/L. ECG confirmed atrial fibrillation rhythm, with controlled ventricular response (±90 bpm).
Clinically, diverticula are reported.
CT scan of the abdomen and pelvis revealed absence of intra-abdominal alterations, except for the absence of contrast uptake by the left kidney, which had normal dimensions and morphology.
The right kidney showed no alterations.
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Subjected to selective renal arteriography, a "stop" image is observed at the common site of the left renal artery, with total occlusion.
Due to the technical impossibility of achieving an intra-arterial thrombolysis "in-situ", a surgical embolectomy was performed through an arteriotomy and removal of the embolus with Fogarty catheter.
Surgical examination confirmed the presence of an impacted embolus in the left main renal artery.
After embolectomy, closure of the arteriotomy and declampage of the artery, there was immediate reperfusion of the kidney.
There were no complications in the postoperative period.
Oral anticoagulant levels were adjusted.
After 12 months of follow-up, the patient remains asymptomatic.
No additional episodes of embolism or development of hypertension were detected.
In the last analytical control, creatinine was 1.1 mg/dL.
However, renal scintigraphy shows marked hypofunction of the left kidney - differential renal function 22%.
