Cocaine-induced renal artery dissection and thrombosis leading to renal infarction.

We present the case history of a 40-year-old man who developed renal artery dissection and thrombosis, probably due to cocaine use. The patient underwent exploratory laparotomy and thrombectomy. He remained asymptomatic and cocaine-free, and warfarin was discontinued 9 months after discharge. Approximately 12 months after discharge he returned to the hospital with symptoms very similar to previous episodes. He was found to have recurrent clot formation in the right renal artery. Further workup revealed a double heterozygous methyltetrahydrofolate reductase A1298C/C677T thermolabile polymorphism with an elevated serum homocysteine.