Kidney - nontumor
Blood vessel disorders
Spontaneous Renal Artery Dissection (SRAD)

Author: Jian-Hua Qiao, M.D., F.C.A.P. (see Authors page)
Editoral Member Review: Maria Tretiakova, M.D., Ph.D.

Revised: 24 April 2017, last major update March 2017

Copyright: (c) 2017, PathologyOutlines.com, Inc.

PubMed search: spontaneous renal artery dissection

Cite this page: Spontaneous Renal Artery Dissection (SRAD). PathologyOutlines.com website. http://pathologyoutlines.com/topic/kidneynontumorsrad.html. Accessed July 26th, 2017.
Definition / general
  • Spontaneous renal artery dissection is a rare entity with fewer than 200 cases reported in the literature
Essential features
  • SRAD is a rare condition and accurate clinical diagnosis is often delayed
    • Clinical presentation of SRAD is nonspecific, including hypertension, hematuria, flank pain or lower back pain as in renal colic
    • SRAD is more common in male patients
    • SRAD usually is unilateral but 10% - 15% of cases involve both renal arteries
    • The consequence of SRAD is renal hypoperfusion, severe hypertension, renal infarction and decreased or lost renal function
    • Treatment includes anticoagulation, revascularization and nephrectomy
Epidemiology
  • Healthy men in fourth to sixth decade of life with 4:1 male to female ratio
Sites
  • Mostly involves one kidney; about 10% - 15% of cases have bilateral involvement
Pathophysiology
  • Renal vascular hypertension, renal insufficiency and renal infarction
Clinical features
  • Flank pain, severe hypertension and renal insufficiency
Diagnosis
  • Abdominal CT with contrast and angiogram
Laboratory
  • Decreased renal function tests
Radiology description
  • CT scan often shows renal infarction, angiogram remains the definitive study (Rev Urol 2007;9:156)
Case reports
Treatment
  • Anticoagulation, endovascular management (stenting or coiling) and nephrectomy
Gross description
  • Dilated renal artery at the hilar region of the affected kidney and variable sized renal infarction
Gross images

Images hosted on PathOut server:

Contributed by Jian-Hua Qiao, M.D., F.C.A.P.:

Various images

Microscopic (histologic) description
  • Renal artery dissection with elongated hematoma in renal artery wall, renal cortical ischemic infarction and renal papillae hemorrhagic infarction
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Jian-Hua Qiao, M.D., F.C.A.P.:

Various images


Various images

Board review question #1
All for the following statements about spontaneous renal artery dissection are correct, EXCEPT:

  1. Spontaneous renal artery dissection is a rare clinical condition
  2. The entity is more commonly seen in male patients
  3. Clinical presentation includes frank pain and hypertension
  4. Spontaneous renal artery dissection usually involves both renal arteries
Board review answer #1
D. Spontaneous renal artery dissection usually involves both renal arteries

Spontaneous renal artery dissection usually involves one renal artery; bilateral disease is only encountered in 10% - 15% of SRAD cases.