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Acute arterial occlusion - kidney

Acute arterial occlusion of the kidney is a sudden, severe blockage of the artery that supplies blood to the kidney.

Causes

The kidneys need a good blood supply. The main artery to the kidney is called the renal artery. Reduced blood flow through the renal artery can hurt kidney function. A complete blockage of blood flow to the kidney can often result in permanent kidney failure.

Acute arterial occlusion of the renal artery can occur after injury or trauma to the abdomen, side, or back. Blood clots that travel through the bloodstream (emboli) can lodge in the renal artery. Pieces of plaque from the walls of the arteries can come loose (on their own or during a procedure). This debris can block the main kidney artery one or one of the smaller vessels.

The risk of renal artery blockages increases in people who have certain heart disorders which make them likely to form blood clots. These include mitral stenosis and atrial fibrillation.

A narrowing of the renal artery is called renal artery stenosis. This condition increases the risk of a sudden blockage.

Symptoms

You may not have symptoms when one kidney does not function because the second kidney can filter the blood. However, high blood pressure (hypertension) may come on suddenly and be difficult to control.

If your other kidney is not working fully, blockage of the renal artery may cause symptoms of acute kidney failure. Other symptoms of acute arterial occlusion of the renal artery include:

  • Abdominal pain
  • Abrupt decrease in urine output
  • Back pain
  • Blood in the urine
  • Flank pain or pain in the side
  • Symptoms of high blood pressure such as headache, change in vision, and swelling

Note: There may be no pain. Pain, if it is present, usually develops suddenly.

Exams and Tests

The doctor will not be able to identify the problem with just an exam unless you have developed kidney failure.

Tests you may need include:

  • Duplex Doppler ultrasound exam of the renal arteries to test blood flow
  • MRI of the kidney arteries, which can show a lack of blood flow to the affected kidney
  • Renal arteriography shows the exact location of the blockage
  • Renal nuclear scan shows a lack of blood flow to the affected kidney
  • Ultrasound of the kidney to check kidney size

Treatment

Often, patients do not need treatment. Blood clots may get better on their own over time.

You may have treatment to open the artery if the blockage is discovered quickly or it is affecting the only working kidney. Treatment to open the artery may include:

  • Clot-dissolving medicines (thrombolytics)
  • Medicines that prevent the blood from clotting (anticoagulants), such as warfarin (Coumadin)
  • Surgical repair of the renal artery
  • Insertion of a tube (catheter) into the renal artery to open the blockage

You may need temporary dialysis to treat acute kidney failure. Medicines to lower cholesterol may be needed if the blockage is due to clots from plaque buildup in the arteries.

Outlook (Prognosis)

Damage caused by arterial occlusion may go away. However, in most cases it is permanent.

If only one kidney is affected, the healthy kidney may take over filtering the blood and producing urine. If you have only one working kidney, arterial occlusion leads to acute kidney failure. This can develop into chronic kidney failure.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if:

  • You stop producing urine
  • You feel sudden, severe pain in the back, flank, or abdomen.

Get emergency medical help right away if you have symptoms of arterial occlusion and have only one working kidney.

Prevention

In many cases, the disorder is not preventable. The most important way to reduce your risk is to stop smoking.

People at risk for developing blood clots may need to take anti-clotting medicines. Taking steps to control diseases related to atherosclerosis (hardening of the arteries) may reduce your risk.

Alternative Names

Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery

References

DuBose TD Jr, Santos RM. Vascular disorders of the kidney. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 127

Scolari F, Ravani P. Atheroembolic renal disease. Lancet. 2010;8:375(9726):1650-60.

Ruggenenti P, Cravede P, Remuzzi G. Microvascular and macrovascular diseases of the kidney. In: Taal MW, Chertow GM, Marsden PA, et al, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 34.

Update Date: 7/2/2013

Updated by: Melissa B Bleicher, MD, Division of Renal, Electrolyte, and Hypertension, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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