Suruchi Kaul M.D.             St. Luke’s Medical Center
Spontaneous renal artery dissections   
         
 

Spontaneous isolated renal artery dissection is a rare condition, and is usually related to abnormalities in the vessel wall, such as atherosclerosis in the older patient and fibromuscular dysplasia in younger patients. We report two 40 year old, male patients with spontaneous, non-traumatic renal artery dissections. The first patient, previously healthy, presented with severe flank pain and elevated blood pressure and creatinine. Urolithiasis/pyelonephritis was initially suspected but a diagnosis of bilateral renal infarcts due to bilateral dissections was established on arteriography. The second patient, with underlying hypertension, also had severe flank pain but a normal creatinine, and dissection of the right renal artery on arteriography. Both patients underwent successful surgical repair with saphenous vein patch angioplasty and have done well on follow-up. The lethality of renal artery dissections and the success of revascularization, which preserves renal function and ameliorates associated renovascular hypertension, emphasize the need for an aggressive approach to the recognition and treatment of this entity. We reviewed the literature on this uncommon condition and present an analysis of its pathology, clinical features, diagnosis, and therapeutic management options.