How acute renal failure led to the diagnosis of aortic coarctation

Abstract

The present case report focuses on a rare presentation of aortic coarctation. A 38-year-old man with well-controlled arterial hypertension, minimal change glomerulonephritis and colitis ulcerosa was suffering from recurrent acute renal failure episodes during viral gastroenteritis. No other symptoms at rest or during physical activity were present. The workup included renal duplex sonography, which unmasked tardus parvus profile in both kidneys without any acceleration of blood flow in the renal arteries. Further examination included CT angiography, which confirmed the diagnosis of aortic coarctation. The observed narrowing of the aorta measured 4 mm and was treated with percutaneous transluminal angioplasty and stent implantation (final diameter 12 mm). After the procedure, the patient had normal blood pressure values without the need of any medication; duplex sonography showed improved renal perfusion. The present case confirms the importance of evaluation for secondary hypertension and thorough workup of acute renal failure in young patients.

FIGURE 1

Exemplary duplex sonography images of the right kidney before (a) and after (b) stenting of the aortic coarctation. (a) Resistive index (RI) before stenting was 0.30 with an increased acceleration time (AT) of 133 ms. Without any direct findings of a renal artery stenosis in the sonography evaluation, this was indicative for a proximal stenosis of the aorta (e.g. aortic coarctation). (b) After stenting, resistive index increased to 0.45 and acceleration time was 84 ms.

FIGURE 2

Contrast-enhanced computed tomography images of thoracic aorta before and after the treatment. (a) and (b) represent initial finding with narrowed postductal aorta segment as low as 4 mm. Red arrows present the affected part of aorta. (c) and (d) represent images at follow-up 3 months after stent placement procedure. At follow-up, an increased lumen diameter (12 mm) was observed.

FIGURE 3

(a) Three-dimensional reconstruction of computed tomography angiography showing the collateral circulation in the presence of aortic coarctation. (b) Three-dimensional reconstruction of computer tomography with angiography showing the aortic coarctation.