Renal Infarction Secondary to Renal Artery Ectasia

We describe a case of renal infarction secondary to renal artery ectasia. A 45 year old male presented to emergency department with sudden onset of left flank pain for one day. Physical examination was significant for tenderness in left upper quadrant and left costovertebral angle with no guarding. Laboratory tests revealed leukocytosis, creatinine 1.4mg/dl, high LDH, and microscopic hematuria. CT abdomen revealed wedge shaped hypodensities in left kidney compatible with renal infarction and focal nonenhancing regions within left renal artery suspicious for thrombus. Subsequent work-up was negative for cardiac and hypercoagulable causes of renal infarction. Urine toxic screen was negative for cocaine. Renal angiogram demonstrated bilateral renal artery ectasias, with left upper pole infarction. He was referred to vascular surgery for endovascular/ surgical intervention. Renal infarction typically occurs due to thromboembolic disease but rare causes like renal artery ectasia as in our patient should also be considered in the differential diagnosis.