Spontaneous renal artery dissection leading to multiple organ dysfunction syndrome and eventual death: A case report.

RATIONALE: Spontaneous renal artery dissection (SRAD) is a rare vascular emergency with high mortality. Early diagnosis remains challenging due to nonspecific clinical manifestations. This case highlights diagnostic and therapeutic dilemmas in managing SRAD, emphasizing the need for multidisciplinary collaboration.

PATIENT CONCERNS: A 35-year-old male with a history of left renal artery stenosis treated by percutaneous transluminal angioplasty 5 years prior presented with sudden right flank pain, nausea, and vomiting. Physical examination revealed abdominal tenderness and hypertension. Laboratory tests showed elevated homocysteine (27.8 μmol/L).

DIAGNOSES: Contrast-enhanced computed tomography confirmed the presence of a longitudinal intimal flap in the main trunk of the right renal artery with complete distal occlusion and extensive renal infarction. No signs of aortic coarctation, mesenteric ischemia, or pulmonary embolism were found.

INTERVENTIONS: Emergency balloon angioplasty and stent implantation were performed. Postprocedure angiography showed partial recanalization of the main renal artery trunk but persistent distal branch occlusion.

OUTCOMES: Despite intervention, the patient deteriorated rapidly, developing cardiac arrest, metabolic acidosis (pH 7.06, Lac 13.8 mmol/L), and multiorgan dysfunction syndrome. Resuscitation efforts failed, and the patient was declared dead 13 hours postadmission.

LESSONS: SRAD mimics acute abdomen or hypertensive crisis, requiring high clinical suspicion in patients with renovascular history. Endovascular intervention improved proximal flow but failed to restore distal perfusion, highlighting anatomical complexity. Chronic medial degeneration (evidenced by restenosis history) may predispose to acute dissection progression. Integration of imaging, laboratory trends, and surgical consultation is critical for timely intervention.