Renovascular acute renal failure precipitated by extracorporeal shock wave lithotripsy for pancreatic stones

Abstract

Extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones is considered a safe and efficient method to facilitate fragmentation and stone removal. We describe the case of a 73-year-old woman with a solitary functioning kidney who presented an acute-onset anuria and renovascular renal failure the day after ESWL. We speculate that vascular calcifications in the area targeted by shock waves played a critical role in renal artery obstruction in the present case.

Keywords: acute kidney injury; pancreatitis; renal arterial thrombosis; vascular calcifications.

Fig. 1.

CT-scan findings. (A) Severe atrophy of the right kidney (arrow) incidentally found on the CT scan (coronal sections; with iodine contrast media) performed 3 months before current admission. (B and C) Extensive calcifications of the aorta and the ostium of the left renal artery (arrowhead) on the CT scan performed after ESWL (transversal sections). The pancreatic prosthesis (asterisk) is located in front of the ostium of the left renal artery.

Fig. 2.

Angiographies of the left renal artery before and after percutaneous luminal angioplasty. (A) Angio-MRI showing the absence of vascularization of the left kidney secondary to an ostial occlusion of the left renal artery (arrowhead). Collateral vascularization suggests chronic blood flow limitation due to atherosclerotic disease. The distal aorta is completely occluded. Haemodialysis was performed immediately after the procedure and on the day after to limit the risk of nephrogenic systemic fibrosis. (B) Arteriography after percutaneous angioplasty of the left renal artery with successful blood flow restoration.

Fig. 3.

Evolution of renal function over time. Bars show daily urine output; points and lines serum creatinine levels. HD, haemodialysis; PTA, percutaneous transluminal angioplasty; LRA, left renal artery; UO, urinary output.