CONGENITAL RENAL ARTERIOVENOUS MALFORMATION-CASE REPORT

Renal arteriovenous malformations (AVM) are abnormal communications between the intrarenal arterial and venous systems. Two types of congenital renal AVM are described. The cirsoid AVM is the most common type. The lesser type is the cavernous AVM. The initial therapy for treatment of AVM is angiographically guided embolization of the malformation. We present our experience with one such case. A 33 years old lady presented with complaints of right loin pain for 3 years which was dull aching and intermittent with radiation to the back. There were no other urological complaints. On examination, the patient was normotensive and had no signs of hyperdynamic circulation except a bruit that was heard over the right renal region. Urine analysis, haemogram and renal function tests were normal. Ultrasound KUB revealed normal sized kidneys with multiple anechoic, tortuous, tubular foci seen in right renal sinus and medulla with intense flow on colour doppler. CT angiogram revealed a 3.5x3.5x 3 cm well defined varicoid lesion in right renal hilum showing early filling of renal vein and vena cava. A segmental artery, probably arising from upper pole was feeding the lesion and a draining vein seen arising from the lesion into the renal vein.After discussing with intervention radiologists, she was planned for therapeutic angioembolisation. Under LA, Seldingers technique, using RDC catheter, renal segmental artery of Right upper pole was catheterized, two stainless steel coils of 5 mm diameter were deployed. Since AVM requires more coils, alcohol injection of 2 ml was also injected into AVM. Check angiogram revealed near complete occlusion of the malformation. Post procedure status was uneventful. Patient is on regular follow up. Congenital AV malformations in kidney may be incidental finding when we evaluate a patient for other vague complaints but once it is diagnosed, immediate therapeutic angioembolisation must be done to prevent further complications.