Acute Anuric Kidney Injury Due to Subtotal Renal Artery Occlusion

Figure

a) Digital subtraction angiography (DSA) of the kidney after passing the occlusion (red dotted line). Through careful administration of CM, the peripheral renal vascular territory is visualized, revealing numerous large-volume thrombi (blue arrows). No parenchymal opacification is seen. b) Following stent graft implantation, there is renewed strong opacification of the renal artery, the vascular tree down to the subsegmental level, and the parenchyma. c) DSA without markers. d) Color Doppler ultrasound of the kidneys in cross section showing no evidence of an arterial flow signal.

An individual in their 60s presented to our emergency department with a 4-day history of anuria. Their creatinine level was 910 µmol/l (10.3, reference, 45–84 µmol/l or 0.5–1.1 mg/dl). The patient history included right nephrectomy 30 years previously. Bedside ultrasound initially ruled out urinary obstruction. There was no evidence of an inflammatory or drug-induced/toxic etiology. Ultrasound on the following day revealed an almost complete absence of perfusion of the left kidney. Based on CT morphology, the suspicion of (subtotal) renal artery occlusion was confirmed. Interventional radiology procedures including aspiration thrombectomy and stentgraft implantation achieved revascularization of the kidney. As a result, diuresis resumed after a cumulative 5-day period of anuria, and creatinine levels returned to normal. Further diagnostic investigations to determine the cause of the thromboembolic event were unremarkable. Post-interventionally, therapeutic heparinization was administered for 72 h, together with dual antiplatelet therapy consisting of acetylsalicylic acid and clopidogrel. Renal artery occlusion is an important differential diagnosis in acute anuric kidney injury, particularly in patients with a solitary kidney.

Ole Hudowenz, Dr. med. Lars Graßhoff, Medizinische Klinik 1, Abteilung für Nephrologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, [e-mail]

PD Dr. med. Malte Maria Sieren, Institut für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck; Institut für Interventionelle Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Hudowenz O, Graßhoff L, Sieren MM: Acute anuric kidney injury due to subtotal renal artery occlusion. Dtsch Arztebl Int 2025; 122: 610. DOI: 10.3238/arztebl.m2025.0073