Renal artery aneurysm is a rare entity in clinical practice. The exact etiology remains unknown, but several risk factors have been detected, including congenital disorders of connective and vascular tissue and long-standing hypertension with ensuing atherosclerosis. The majority of patients are asymptomatic and the diagnosis is often made incidentally. Flank pain, hematuria, and hypertension are reported in symptomatic cases. Imaging studies, such as ultrasonography and computed tomography (CT) are necessary to identify the aneurysm and its size. Surgery is usually the therapeutic method of choice.
The clinical presentation of a renal artery aneurysm (RAA) is often asymptomatic, as up to 55% of cases are without any complaints at the time of diagnosis  . Hypertension is, however, by far the most common finding, but it is rarely considered to be a specific sign of RAA   . Mean blood pressure measurements at the time of identification of the disease are about 150/90 mmHg and patients often suffer from hypertension for several years prior to aneurysm treatment . Accompanying symptoms that have been reported include flank pain and hematuria ranging from microscopic to very large macroscopic hematuria  . In rare cases, a pulsatile abdominal mass (only seen in very large aneurysms) and vascular bruits might be observed . Complications of renal artery aneurysms are very rare, but rupture of this structure occurs in 3% of cases and predisposes individuals to fatal hemorrhage , meaning that an early diagnosis is critical. In addition to hypertension, renal artery fibrodysplasia was established as an important risk factor in the pathogenesis of RAA, followed by atherosclerotic plaques that occlude the artery and promote hypertension, but also tobacco smoking  . RAAs can be solitary or multiple (either in unilateral or bilateral distribution), and a relatively equal predisposition of left and right vessels is observed . Some studies, however, claim it is more frequent in men (around 60 years of age) and that the right renal artery is the predominant site for an aneurysm formation  .
Entire Body System
- Left Flank Pain
A 41-year-old nonpregnant normotensive woman known to have NF-1 presented to our emergency department with left flank pain. Computed tomography showed a large retroperitoneal hematoma due to left renal artery aneurysm rupture. [ncbi.nlm.nih.gov]
Case Report A 63-year-old female presented with frequency and dysuria, and despite oral antibiotics developed severe left flank pain and fevers requiring admission for IV antibiotics. [omicsonline.org]
- Right Flank Pain
Discussion In 1770, Rouppe found a large false renal aneurysm with rupture in an autopsy of a patient who died with right flank pain. [vasculardiseasemanagement.com]
Intrarenal pseudoaneurysm presenting with microscopic hematuria and right flank pain. Can J Urol. 2007 Jun. 14(3):3588-91. [Medline]. Rautio R, Haapanen A. Transcatheter embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer. [emedicine.medscape.com]
- Acute Abdomen
- Abdominal Bruit
Otherwise, patients may present with arterial hypertension, pain, hematuria, abdominal pulsatile mass or abdominal bruit. Hypotension, shock and acute abdomen may be caused by a ruptured aneurysm. [urology-textbook.com]
- Recurrent Abdominal Pain
A 57-year-old male smoker with a history of recurrent abdominal pain was diagnosed with a 5.1-cm right renal artery aneurysm near the hilum. [ncbi.nlm.nih.gov]
- Vascular Disease
Even though the present case represents an extremely rare clinical manifestation of intraparenchymal renal artery aneurysm, clinicians should be aware that imaging studies cannot distinguish all instances of renal vascular disease. [ncbi.nlm.nih.gov]
Overview Renal Artery Aneurysms Renal Vascular Disease What is renal vascular disease? Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. [indiahospitaltour.com]
diseases I73.0 Raynaud's syndrome I73.00 …… without gangrene Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. [icd10data.com]
Symptoms of renal vascular disease include sudden onset of hypertension, hypertension not responsive to three or more blood pressure medications, increased urea (waste product excreted by kidneys) in blood, and unexplained kidney failure. [barnesjewish.org]
Face, Head & Neck
- Wide Neck
A 56-year-old woman with history of hypertension presented with a 2.5-cm wide-necked saccular aneurysm involving her distal right renal artery. [ncbi.nlm.nih.gov]
Coil embolization of the aneurysm sac was treatment of choice for the patient and due to wide neck stent-assisted embolization was performed. [apscvir.com]
Suboptimal results may occur when treating wide-necked aneurysms with this technique, even with stent-assisted embolization.9 2. [vasculardiseasemanagement.com]
- Cesarean Section
Here we describe a patient with an intraparenchymal renal artery aneurysm that ruptured after a cesarean section but was immediately identified and managed appropriately, allowing for a successful outcome. [ncbi.nlm.nih.gov]
Cesarean section was done immediately, there was no signs of placental abruption as the placenta was upper, posterior and fully attached to the uterine wall. She gave birth of a baby boy (2.2 Kg), Apgar score (1,6,8), admitted to the NICO. [bmcurol.biomedcentral.com]
The diagnosis of a renal artery aneurysm may not be so easy to attain, especially in the absence of symptoms. Given the frequent incidental finding of an RAA, the increased use of imaging modalities for the purposes of screening or evaluation of other organs have markedly increased the number of identified cases   . For this reason, the physician must obtain a thorough patient history and conduct a meticulous physical examination that focuses on the assessment of blood pressure. A family history is also important in the initial interview, as the autosomal dominant polycystic disease, tuberous sclerosis, and other congenital disorders carry a higher rate of RAA  . As soon as clinical suspicion is raised, imaging studies need to be employed. Various procedures are recommended, including ultrasonography (with doppler technique), CT, magnetic resonance imaging (MRI), nuclear scintigraphy, and MR angiography (MRA)  . Ultrasonography is used as a first-line study that provides a good view into the renal vessels and is often recommended as a screening method every 6-12 months when smaller aneurysms are identified , but either CT (contrast-enhanced) or MRA are considered to be the gold standard, with very high rates of detection  . The importance of more advanced procedures lies in the fact that aneurysm size, as well as type, must be determined, mainly in order to devise the optimal therapeutic strategy.
We report a case of endovascular treatment of a complex renal artery aneurysm using the Pipeline Embolization Device, a flow diverting stent which is indicated for the treatment of large and giant cerebral aneurysms. [ncbi.nlm.nih.gov]
Treatment and prognosis Management depends on various factors like age, sex, severity of hypertension, anticipated pregnancy, and aneurysm morphology. [radiopaedia.org]
Herrlin Renal artery aneurysms: natural history and prognosis Ann Surg, 197 (1983), pp. 348-352  P.K. Henke, J.D. Cardneau, T.H. [elsevier.pt]
Prognosis The morbidity and mortality associated with elective RAA repair are very low. [emedicine.medscape.com]
Renal artery aneurysm is a rare condition that has an unclear etiology. Although some patients present with symptoms of hypertension, pain, hematuria, or rupture, the majority are asymptomatic. [ncbi.nlm.nih.gov]
The diagnosis depends upon an awareness of the possible role of the avascular kidney in the etiology of hypertension and the investigation of this potential etiologic factor in all hypertensive patients. [annals.org]
Etiology fibromuscular dysplasia (FMD): 35% degenerative aneurysm: 25% vasculitides, e.g. Behcet disease phakomatoses, e.g. tuberous sclerosis, neurofibromatosis intrinsic collagen deficiency, e.g. [radiopaedia.org]
Etiological research of aneurysms showed no underlying vasculitis. [casereports.in]
We describe the case and review the literature surrounding the epidemiology, outcome and management of renal artery aneurysms. [ncbi.nlm.nih.gov]
Epidemiology 1:300 to 1:1000. Etiology of renal artery aneurysm Congenital disorder, arteriosclerosis, traumatic or iatrogenic causes, inflammation. Signs and Symptoms In 50%, an aneurysm of the renal artery does not cause any symptoms. [urology-textbook.com]
Causes include the following: Polyarteritis nodosa Tuberculosis Neurofibromatosis Epidemiology Autopsy studies indicate that the incidence of RAA is in the range of 0.01-0.09%.  In selected patients who undergo renal arteriography, a higher incidence [emedicine.medscape.com]
The pathophysiology of hypertension in patients with RAAs is not well understood but may be related to localized ischemia secondary to kinking of the renal artery branch, turbulence in the aneurysm, distal embolization from the aneurysm, or coexisting [evtoday.com]
RAAs are associated with hypertension in up to 73% of cases. 3 Hypotheses on the pathophysiological basis of hypertension include microembolization from the aneurysm, coexisting renal artery stenosis, compression or kinking of the renal artery or its [elsevier.pt]
Pathophysiology In true aneurysms, a weakening then dilatation of all layers of the arterial wall occurs. In fibromuscular dysplasia (FMD), the degenerative fibroplasia-type changes lead to this wall weakening. [emedicine.medscape.com]
We performed ex vivo reconstruction using an organ preservation solution to prevent postoperative renal failure. [ncbi.nlm.nih.gov]
The aneurysms were treated with placement of a polytetrafluoroethylene (PTFE)-coated stent, in order to prevent expansion and rupture of the aneurysms and to treat the hypertension. [elsevier.pt]
- Henke PK, Cardneau JD, Welling TH, et al. Renal Artery Aneurysms: A 35-Year Clinical Experience With 252 Aneurysms in 168 Patients. Ann Surg. 2001;234(4):454-463.
- Seo PW. Surgical Treatment of Ruptured Renal Artery Aneurysm: A Report of 2 Cases. Korean J Thorac Cardiovasc Surg. 2013;46(6):467-470/
- Titze N, Ivanukoff V, Fisher T, Pearl G, Grimsley B, Shutze WP. Surgical repair of renal artery aneurysms. Proc (Bayl Univ Med Cent). 2015;28(4):499-501.
- Wason SE., Schwaab T. Spontaneous Rupture of a Renal Artery Aneurysm Presenting as Gross Hematuria. Rev Urol. 2010;12(4):e193-e196.
- Tham G, Ekelund L, Herrlin K, et al. Renal artery aneurysms. Natural history and prognosis. Ann Surg. 1983;197:348–352.
- Porcaro AB, Migliorini F, Pianon R, et al. Intraparenchymal renal artery aneurysms. Case report with review and update of the literature. Int Urol Nephrol. 2004;36:409–416.