Renal arteriovenous fistulas presenting as painless gross hematuria in a young adult male: A case report

Renal arteriovenous fistulas (AVFs) are rare vascular abnormalities that may present with gross hematuria. Diagnosis can be challenging when conventional imaging modalities fail to detect subtle or intrarenal vascular lesions. We report a case of a 31-year-old male presenting with painless gross hematuria in whom both computed tomography (CT) and magnetic resonance imaging (MRI) were nondiagnostic. Diagnostic ureteroscopy excluded urothelial malignancy, and subsequent renal angiography revealed a high-flow AVF arising from intrarenal arterial branches. The lesion was successfully treated with superselective coil embolization, resulting in immediate resolution of gross hematuria and preservation of renal function. This case highlights the limitations of cross-sectional imaging and underscores the diagnostic and therapeutic value of angiography in patients with persistent unexplained gross hematuria.