A 33-year-old man with a history of smoking (20 cig/day) and an episode of urolithiasis at 27 years of age.
She presented with severe pain in the right flank, with onset, without irradiation, associated with nausea and vomiting on a sudden onset spontaneously.
The clinical picture was repeated 5 h later, with similar characteristics to the previous one.
The patient had no fever and physical examination showed a blood pressure of 140/82 mmHg and pain on palpation of the right iliac fossa (FID).
Laboratory tests showed complete urine without hematuria, hemogram with leukocytosis (17,200 x mm3), creatinine of 1.2 mg/dl and LDH of 1.457 IU/1.
PyeloTC was performed, which turned out to be negative for urolithiasis, with right renal infarction CT of the abdomen and partial pelvis, in which an extensive hypodense area of cuneiform aspect was observed in the posterior aspect of the paren.
The patient was hospitalized.
Thrombophilia tests were performed, whose results were normal, prior to the start of anticoagulation (HFmin and Neosintron).
Transesophageal echocardiography was also performed, which was normal and CT angiography revealed the presence of a dominant right renal artery (DA) and a smaller polar artery with normal course, and image compatible with renal infarction with arterial wall.
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The polar artery was narrowed with angiographic study, which revealed normal angiography, altered perfusion of the upper pole, anterior and posterior aspect of the right kidney, with no compromise of perfusion of the lower pole given by the coronary artery.
The dominant renal artery was irregular and originated from its middle third and presented a dissection flap that compromised the origin of the interlobar branches, thus limiting the distal flow.
The dissection flap was described as highly complex with no possibility of endovascular maneuvers.
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Two days later she presented a new episode of pain in the right flank.
Nine angioCT showed a clear progression of renal infarction in the upper 2/3 of the right kidney.
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The patient had hypertension in the range of 160/100 mmHg and without deterioration of renal function (creatininemia 1.2 mg/dl).
She was discharged with antihypertensive therapy (Blox 4 mg/day) in good general condition for outpatient management.
In ambulatory control at two and seventeen days after discharge the patient was asymptomatic, normotensive and with the rest of the physical examination without pathological findings.
