CONGENITAL RENAL ARTERIOVENOUS MALFORMATION-CASE REPORT

Abstract

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.