Ruptured Renal Artery Aneurysm

Introduction: Renal artery aneurysms (RAAs) are rare. Absolute incidence of renal artery aneurysms is unknown. Most RAAs are diagnosed incidentally during imaging for evaluating another pathology. Renal artery aneurysms are common in females due to fibromuscular dysplasia. Most patients with renal artery aneurysm do not have traditional cardiovascular risk factors. However, the majority are smokers and hypertensive. Sometimes RAAs are diagnosed at the time of rupture which present with nonspecific signs and symptoms like hypotension and abdominal pain. We are presenting the case of RAAs complicated by rupture. Case Description: A 75-year-old male with history of light chain AL amyloidosis with cardiac involvement, multiple myeloma, hypertension, hyperlipidemia, chronic diastolic CHF, coronary artery disease, CKD stage V, AV fistula creation, nephrolithiasis, acquired cystic renal disease was admitted for chills, generalized weakness and fatigue. After investigations, the patient was diagnosed with UTI and was treated for sepsis secondary to UTI. In the hospital he developed right flank pain which slowly increased in intensity associated with hypotension and acute blood loss anemia with concern for right renal bleed. Emergent CTA with contrast was done which showed right renal bleed and perirenal hematoma causing Paige kidney. An emergency renal angiogram was done which showed a small lower pole hemorrhage which was super selectively embolized with micro coil. However, additional angiograms showed 4-5 more additional pseudoaneurysms throughout the right kidney and diffuse vascular irregularity. And shared decision was made during the procedure to completely right renal artery embolization as renal function is very poor anyway in the setting of CKD V. Discussion: Renal artery aneurysms are rare and often not diagnosed and can rupture suddenly causing life threatening bleed. The diagnosis is often made incidentally during imaging while evaluating for another pathology. The risk factors that should raise the suspicion are smoking, hypertensive, concomitant atherosclerosis, ipsilateral FMD, non-renal artery aneurysms. Our case report emphasizes recognizing the other associated conditions and risk factors to warrant further investigation of RAAs.