Renal Arterial Embolization

Renal embolization is characterized by abdominal pain, flank tenderness, fever, leukocytosis, albuminuria, and a urinary sediment containing leukocytes and small numbers of erythrocytes. The emboli are usually delivered to the systemic circulation from a left atrial thrombus proximal to a diseased mitral valve or a ventricular thrombus adherent to an old myocardial infarction. The excretory urogram demonstrates a heminephrogram or a total failure of excretion of contrast material. Angiography establishes the location of the emboli, the degree of renal artery obstruction, the extent of the collateral circulation, and the status of the opposite kidney. Surgical evacuation of the renal vasculature is indicated when there is a solitary kidney or anuria in association with bilateral emboli. Although irreversible infarction develops rapidly with total arterial interruption, a surprising degree of potential renal function is preserved if the angiogram demonstrates partial perfusion of the kidney distal to the emboli. The survival of ischemic kidney may produce renovascular hypertension. Cardiac surgery should be considered for patients with rheumatic heart disease because the major risk to life is recurrent systemic embolization. Anticoagulation is indicated in patients treated without surgery.