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Renal Arteriovenous Fistula

Renal AV Fistula


Presentation

  • Renal arteriovenous fistula (AVF) presents a rare but important condition that can be acquired, congenital, or idiopathic.[ncbi.nlm.nih.gov]
  • Discussion Renal AV fistula is an unusual presentation as discussed above. It is usually difficult to diagnose. Patients usually present with hypertension and hematuria [ 3 ].[omicsonline.org]
Mediastinal Lymphadenopathy
  • Shortly after resection, she was found to have bibasilar lung nodules and mediastinal lymphadenopathy, which was subsequently confirmed to be metastatic RCC.[erj.ersjournals.com]
Renal Artery Stenosis
  • Introduction In the evaluation of hypertension, an abdominal bruit normally suggests renal artery stenosis as the cause of the hypertension.[academic.oup.com]
  • In young children, the most common causes of hypertension are renal parenchymal disease, renal artery stenosis, and coarctation of the aorta.[accesspediatrics.mhmedical.com]
  • Doppler ultrasound is highly specific in cases of transplanted renal artery stenosis, pseudoaneurysms, arteriovenous fistulas, and thrombosis with complete or partial artery or vein occlusion.[ncbi.nlm.nih.gov]
  • Transplant renal artery stenosis (TRAS).[cjasn.asnjournals.org]
Abdominal Bruit
  • Radiographic contrast aortography and radionuclide dynamic scintigraphy were used to diagnose a congenital renal arteriovenous fistula in a 33 year old woman who presented with hypertension, cardiac decompensation and abdominal bruit.[ncbi.nlm.nih.gov]
  • Introduction In the evaluation of hypertension, an abdominal bruit normally suggests renal artery stenosis as the cause of the hypertension.[academic.oup.com]
Right Flank Pain
  • A 50-year-old Japanese man presented with right flank pain and gross hematuria. The patient had undergone non-ischemic tumor enucleation for right renal cell carcinoma, 2 cm in diameter, 1 month previously.[ncbi.nlm.nih.gov]
Heart Failure
  • Her symptoms and cardiovascular changes were consistent with congestive heart failure and severe preeclampsia.[ncbi.nlm.nih.gov]
Vascular Disease
  • This case report describes the challenges in diagnosing PAN and highlights the importance of a holistic approach when encountering patients with multiple vascular diseases.[ncbi.nlm.nih.gov]
  • The Dialysis Outcomes and Practice Patterns (DOPPS) III reports that patients were less likely to use an AVF if they were female, of older age, had a greater body mass index or had diabetes, peripheral vascular disease or recurrent cellulitis/gangrene[advancedrenaleducation.com]
  • Causes of Hypertension in Children Renal parenchymal disease Chronic pyelonephritis Cystic disease Glomerulonephritis Nephritis Reflux nephropathy Renal dysplasia Neoplasm Trauma Focal infarction Page kidney Renal vascular disease Coarctation of the aorta[accesspediatrics.mhmedical.com]
Decreased Diastolic Blood Pressure
  • The physical manifestations of this would be a relatively normal systolic blood pressure with a decreased diastolic blood pressure resulting in a wide pulse pressure.[en.wikipedia.org]
  • The physical manifestations of this would be a relatively normal systolic blood pressure with a decreased diastolic blood pressure resulting in a wide (large) pulse pressure.[wikidoc.org]
Diastolic Hypertension
  • Increased renin secretion in this instance supports the proposed mechanism of diastolic hypertension with renal arteriovenous fistula.[ncbi.nlm.nih.gov]
Wide Pulse Pressure
  • The physical manifestations of this would be a relatively normal systolic blood pressure with a decreased diastolic blood pressure resulting in a wide pulse pressure.[en.wikipedia.org]
Denial
  • The challenges come from two main areas: (1) actually convincing the patient to go ahead with it (there are often very powerful mechanisms of denial involved in a patient actually accepting the fact that they are eventually headed for dialysis), and ([renalfellow.blogspot.com]
Microscopic Hematuria
  • CASE REPORT: A 42-year-old woman with microscopic hematuria was found to have a massive idiopathic renal AVF.[ncbi.nlm.nih.gov]
Premature Ejaculation
  • Brand-new chapters and comprehensive updates throughout include new information on perioperative care in adults and children, premature ejaculation, retroperitoneal tumors, nocturia, and more![books.google.de]

Workup

  • If assessed to be at risk for rupture, a workup for associated access infection should be considered and a surgical consult for aneurysm repair initiated. Dual antiplatelet therapy should be avoided in patients with AV fistula aneurysms.[hindawi.com]
Hyperreninemia
  • The normal split function studies, renogram and renal vein renins do not support the concept of secondary hyperreninemia as a causative factor in the hypertension seen with renal arteriovenous fistulas.[ncbi.nlm.nih.gov]
Right Bundle Branch Block
  • The electrocardiogram recorded a right bundle branch block pattern (QRS 0.09 s) with a normal QRS axis and sinus bradycardia (HR 55 beat/min). Thoracic radiographs showed enlargement of the heart with widening of the right-outflow tract.[academic.oup.com]

Treatment

  • Interventional embolization is currently the first line treatment for arteriovenous fistulas; however, the efficacy of repeated embolization remains controversial.[ncbi.nlm.nih.gov]

Prognosis

  • The advanced therapeutic tools we used can improve the prognosis of patients with large and complicated arteriovenous fistulas and prevent surgery.[ncbi.nlm.nih.gov]
  • Treatment and prognosis Renal AVFs usually resolve spontaneously. It may be treated whenever it is symptomatic, large or extra-renal 1,4 . The therapeutic method of choice is endovascular intervention.[radiopaedia.org]
  • Natural history and prognosis. Ann Surg 1983; 197 (3) 348-352 9 Ogawa S, Yanagida T, Kataoka M, et al. Laparoscopic nephrectomy, ex vivo angioplasty, and renal autotransplant for a renal artery aneuryms: A case report.[thieme-connect.com]
  • In AKI, other considerations include: Sodium 155 mmol/L or Severe acidosis (pH Severe renal failure – e.g. creatinine 500, urea 30 mmol/L Drug toxicity with drugs than can be dialysed Prognosis Prognosis in AKI is worse if oliguria is present.[almostadoctor.co.uk]
  • Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci . 2011;48(4):155–170. 24. Hogevik H, Olaison L, Andersson R, Alestig K.[dovepress.com]

Etiology

  • Etiology of Renal AV Fistula Congenital (25%): varicose-like multiple connections between artery and vein, most common at the upper pole of the kidney, female:male 3:1 Renal trauma Iatrogenic causes: renal biopsy, kidney surgery Inflammatory etiology[urology-textbook.com]
  • This book serves these needs well through a nicely balanced focus on prevention, on the one hand, with its comprehensive review of epidemiology and etiology, and on management, on the other, with its practical comments on diagnosis, treatment and outcome[books.google.de]
  • Etiologies include congenital, trauma, malignancies, surgery and percutaneous kidney biopsies [ 1, 3 ]. Treatment and management include transcatheter coil embolization, surgical resection, or a combination of the two for definitive treatment [ 3 ].[omicsonline.org]
  • Renal arteriovenous-fistulas - a review of etiology, diagnosis, and management. Surgery 1986 ; 99 : 114 –118. Rodgers MV, Moss AJ, Hoffman M, Lipchik EO. Arteriovenous fistulae secondary to renal cell carcinoma.[erj.ersjournals.com]
  • It is known that inflammation due to other stimuli such as syphilitic infection of the aortic wall constitutes an etiology for the development of aortocaval fistulas [19].[egms.de]

Epidemiology

  • This book serves these needs well through a nicely balanced focus on prevention, on the one hand, with its comprehensive review of epidemiology and etiology, and on management, on the other, with its practical comments on diagnosis, treatment and outcome[books.google.de]
  • Epidemiology and outcome of infective endocarditis in hemodialysis patients. Am J Med Sci . 2002;324(5):254–260. 32. Rekik S, Trabelsi I, Hentati M, et al.[dovepress.com]
  • Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004;17:863-93. 21.[sjkdt.org]
  • Epidemiology Renal AVMs are uncommon. The estimated rate in large autopsy series is lower than 1 case per 30,000 patients.[emedicine.medscape.com]
  • Key words Radiocephalic fistula thrombosis, primary fistula failure, heparin in radio cephalic fistula, maturation of fistula Abbreviations AVF: Atriovenous fistula; RCF: Radiocephalic fistula; ESFF: End stage renal failure Introduction Epidemiology The[oatext.com]
Sex distribution
Age distribution

Pathophysiology

  • The underlying pathophysiology was believed to be caused by the high-output state of pregnancy and by the increased peripheral vascular resistance of preeclampsia.[ncbi.nlm.nih.gov]
  • Large A-V fistula: pathophysiological consequences and therapeutic perspectives. Curr Vasc Pharmacol. 2003 Oct;1(3):347-54. DOI: 10.2174/1570161033476619 10. Nagahara A, Nishimura K, Okuyama A.[egms.de]
  • In 1934, Goldblatt established the pathophysiology of renovascular hypertension, showing that reduction in total blood flow because of the occluding process and the loss of pulsatile character in the artery cause the juxtaglomerular apparatus to secrete[vasculardiseasemanagement.com]
  • […] disease. [3] Predisposing factors include arteriosclerosis, fibromuscular dysplasia (FMD), congenital malformations of the kidney, renal angiomyolipoma, pregnancy and trauma. [4] Traumatic and iatrogenic renal artery pseudoaneurysms represent yet another pathophysiologic[sjkdt.org]
  • Hemodynamics and pathophysiology of arteriovenous fistulae. In: Rutherford RB, ed. Vascular Surgery. 5th ed. Philadelphia, PA: WB Saunders; 2000. Dickey KW, Pollak JS, Meier GH III, et al.[evtoday.com]

Prevention

  • The advanced therapeutic tools we used can improve the prognosis of patients with large and complicated arteriovenous fistulas and prevent surgery.[ncbi.nlm.nih.gov]

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