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Due to the fact that renal artery thrombosis has been described that have an incidence of 2% in the Mexican population, and that, in addition, it has a wide variety of presentations that can simulate other causes of acute abdominal pain, lumbar pain or even the presence of a hypertensive crisis, it’s diagnosis can be difficult to determine, resulting in a poor renal prognosis for the patient in the face of late surgical intervention.
Case presentation: 66-year-old female with no comorbidities. History of infrarenal abdominal aortic aneurysm of 51 mm partially thrombosed 1 year ago, operated with prosthesis. She came to the emergency room with severe pain in the right flank, went to the operating room with suspicion of appendicitis. An appendectomy was performed, with no eventualities. 48 hours later she presented anuria and blood pressure >180/100 mmHg. Acute renal injury was addressed, requiring hemodialysis due to hyperkalemia and metabolic acidosis; renal ultrasound was performed (Image 1) where asymmetry and low resistance indices were found in both renal arteries, so a computed tomography angiography was requested (Image 2) where it was found that there was no contrast flow through the right renal artery and there was also a delay in left renal uptake.
Infarction of the right renal artery and data suggestive of previous contralateral infarction were found, the patient remains on hemodialysis since then in the absence of improvement with conservative treatment due to being out of the window for surgical management and left kidney with atrophy secondary to the same etiology.
Catastrophic complications in the quality of life of a patient diagnosed late with renal arterial thrombosis morally oblige the clinical and surgical staff to work in a multidisciplinary and judicious manner to rule out other differential diagnoses that may simulate common causes of acute abdomen.