Rare Case of Acute Renal Artery Thrombosis in Nephrotic Syndrome: The Unusual Presentations and Outcomes of Endovascular Manual Aspiration Thrombectomy

Renal artery thrombosis is a rare condition that requires early diagnosis and urgent intervention to prevent renal infarction and permanent renal damage. Possibility of renal artery thrombosis should be considered in patients with underlying hypercoagulable state presented with acute unremitting flank pain, nausea and vomiting. We report a case of a 35-year-old man with underlying nephrotic syndrome who presented with three days history of acute non-localized and non-resolving abdominal pain and vomiting. He was initially referred to general surgery for acute intestinal obstruction. Contrast-enhanced computed tomography (CECT) abdomen revealed acute left renal infarction secondary to total thrombotic occlusion of the left renal artery. The patient was treated with endovascular manual aspiration thrombectomy resulting in partial revascularization of left renal artery with restoration of renal function, complete resolution of symptom and good clinical outcomes. This case report serves as a reminder for physicians to include renal infarction in the differential diagnosis when evaluating a patient with acute abdomen, particularly in patient with hypercoagulable state. This case also aligns with other experiences demonstrating positive outcomes after endovascular thrombectomy, even in the presence of prolonged renal ischemia time of more than 72 hours.