Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study
Abstract Background Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either...
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doaj-29b14acbb01b4ce396fb7adb9ba3163c2020-11-25T03:45:08ZengBMCBMC Nephrology1471-23692019-10-012011810.1186/s12882-019-1559-8Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case studyYoshihiro Mukaiyama0Akira Okada1Yutaro Kawakatsu2Satoshi Akuzawa3Kazuchika Suzuki4Naoyuki Ishigami5Tatsuo Yamamoto6Department of Urology, Takashimadaira Chuo General HospitalDivison of Nephrology and Endocrinology, The University of Tokyo Graduate School of MedicineDepartment of Nephrology, Fujieda Municipal General HospitalDepartment of Cardiovascular Surgery, Fujieda Municipal General HospitalDepartment of Cardiovascular Surgery, Fujieda Municipal General HospitalDepartment of Cardiovascular Surgery, Fujieda Municipal General HospitalDepartment of Nephrology, Fujieda Municipal General HospitalAbstract Background Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries. Case presentation We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries. He had AKI, which unexpectedly progressed to ESKD, without any radiological evidence of direct involvement of the renal arteries. Thus, we failed to attribute the ESKD to the dissection and hesitated to perform any surgical intervention. Nevertheless, the patient’s hormonal levels, fractional excretion values, ankle brachial indices, and Doppler resistive indices seemed to indirectly suggest kidney malperfusion and implied renal artery hypo-perfusion. However, abdominal computed tomography imaging only revealed progressive thrombotic obstruction of the false lumen and compression of the true lumen in the descending thoracic aorta, despite the absence of anatomical blockage of renal artery perfusion. Later, signs of peripheral malperfusion, such as intermittent claudication, necessitated surgical intervention; a graft replacement of the aorta was performed. Post-operatively, the patient completely recovered after 3 months of haemodialysis, and the markers that had pre-operatively suggested decreased renal bloodstream normalised with recovery of kidney function. Conclusions To the best of our knowledge, this is the first report of severe AKI, secondary to aortic dissection, without direct renal artery obstruction, which progressed to “temporary” ESKD and was resolved following surgery. This case suggests that only coarctation above the renal artery branches following an aortic dissection can progress AKI to ESKD, despite the absence of radiological evidence confirming an obvious anatomical blockage. Further, indirect markers suggestive of decreased renal blood flow, such as ankle brachial indices, renal artery resistive indices, urinary excretion fractions, and hormonal changes, are useful for evaluating concomitant AKI and may indicate the need for surgical intervention after a Stanford type B aortic dissection.http://link.springer.com/article/10.1186/s12882-019-1559-8Aortic dissectionAcute kidney injuryEnd-stage kidney diseaseSurgeryStatic obstructionDynamic obstruction |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yoshihiro Mukaiyama Akira Okada Yutaro Kawakatsu Satoshi Akuzawa Kazuchika Suzuki Naoyuki Ishigami Tatsuo Yamamoto |
spellingShingle |
Yoshihiro Mukaiyama Akira Okada Yutaro Kawakatsu Satoshi Akuzawa Kazuchika Suzuki Naoyuki Ishigami Tatsuo Yamamoto Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study BMC Nephrology Aortic dissection Acute kidney injury End-stage kidney disease Surgery Static obstruction Dynamic obstruction |
author_facet |
Yoshihiro Mukaiyama Akira Okada Yutaro Kawakatsu Satoshi Akuzawa Kazuchika Suzuki Naoyuki Ishigami Tatsuo Yamamoto |
author_sort |
Yoshihiro Mukaiyama |
title |
Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study |
title_short |
Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study |
title_full |
Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study |
title_fullStr |
Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study |
title_full_unstemmed |
Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study |
title_sort |
complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study |
publisher |
BMC |
series |
BMC Nephrology |
issn |
1471-2369 |
publishDate |
2019-10-01 |
description |
Abstract Background Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries. Case presentation We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries. He had AKI, which unexpectedly progressed to ESKD, without any radiological evidence of direct involvement of the renal arteries. Thus, we failed to attribute the ESKD to the dissection and hesitated to perform any surgical intervention. Nevertheless, the patient’s hormonal levels, fractional excretion values, ankle brachial indices, and Doppler resistive indices seemed to indirectly suggest kidney malperfusion and implied renal artery hypo-perfusion. However, abdominal computed tomography imaging only revealed progressive thrombotic obstruction of the false lumen and compression of the true lumen in the descending thoracic aorta, despite the absence of anatomical blockage of renal artery perfusion. Later, signs of peripheral malperfusion, such as intermittent claudication, necessitated surgical intervention; a graft replacement of the aorta was performed. Post-operatively, the patient completely recovered after 3 months of haemodialysis, and the markers that had pre-operatively suggested decreased renal bloodstream normalised with recovery of kidney function. Conclusions To the best of our knowledge, this is the first report of severe AKI, secondary to aortic dissection, without direct renal artery obstruction, which progressed to “temporary” ESKD and was resolved following surgery. This case suggests that only coarctation above the renal artery branches following an aortic dissection can progress AKI to ESKD, despite the absence of radiological evidence confirming an obvious anatomical blockage. Further, indirect markers suggestive of decreased renal blood flow, such as ankle brachial indices, renal artery resistive indices, urinary excretion fractions, and hormonal changes, are useful for evaluating concomitant AKI and may indicate the need for surgical intervention after a Stanford type B aortic dissection. |
topic |
Aortic dissection Acute kidney injury End-stage kidney disease Surgery Static obstruction Dynamic obstruction |
url |
http://link.springer.com/article/10.1186/s12882-019-1559-8 |
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