Acute unilateral renal embolism: a therapeutic challenge

Acute renal artery embolism (ARAE) is a rare vascular event that precipitates renal infarction (RI) caused by abrupt disruption of renal artery blood flow. RI is frequently misdiagnosed or diagnosed late because of its rarity and frequently ambiguous clinical presentation, potentially leading to irreversible harm to the renal parenchyma or an increased risk of other embolic events affecting other organs. Risk factors for ARAEs include atrial fibrillation, valvular or ischemic heart disease, renal artery embolism/dissection, and coagulopathy, and complete unilateral renal artery embolism is rare. We present the case of one patient with unilateral ARAE caused by atrial fibrillation. We performed percutaneous endovascular therapy (PET) for the renal artery embolism, including catheter-directed thrombolysis (CDT) and aspiration thrombectomy with systemic anticoagulant therapy. At the one-year follow-up, severe atrophy of the affected kidney and compensatory enlargement of the contralateral kidney were observed. We found that procedurally successful revascularization does not necessarily translate to functional recovery of the renal parenchyma. To accurately assess long-term renal functional restoration, we propose incorporating post-thrombectomy anatomical evaluations (e.g., via renal artery angiography or CT angiography [CTA]) combined with functional renal scintigraphy into standardized clinical protocols. This multimodal approach would not only validate the angiographic outcomes but also provide critical insights into the viability of the parenchyma, thereby guiding the development of patient-specific therapeutic strategies. Recommendations for optimal treatment for renal artery embolism are needed. Therefore, we share this case with the aim of providing valuable information for the treatment of renal infarction.