Renal Arteriovenous Fistula Presenting with Acute Pyelonephritis: A Rare Case Report
Chi-Bo Lin, Hung-Jen Shih, Jesun Lin, Chang-Pao Chang, Bai-Fu Wang, Meng-Yi Yan, Sheng-Hsien Huang, Chun-Chi Chen, Herng-Jye Jiang, Jian-Xiang Zhang, Pao-Hwa Chen, Yi-Zhong Chen, Pan Yueh
Division of Urology, Department of Surgery, Changhua Christian Hospital
Renal arteriovenous fistula (AVFs) are anomalous direct communications between arteries and veins in the kidney. Their prevalence is approximately 0.04% of the general population. However, the true prevalence may be higher because many renal AVFs remain clinically asymptomatic. Clinical presentations include massive hematuria, retroperitoneal hemorrhage, flank pain, hypertension, and high-output heart failure, etc. Renal AVFs usually resolve spontaneously. It may be treated whenever it is symptomatic, large or extrarenal. The therapeutic method of choice is endovascular intervention and surgical treatment, including partial or total nephrectomy or arterial ligation. Surgical treatment is now performed in limited cases in which endovascular embolization failed or would have been technically difficult.
A 25-year-old female patient with history of bilateral vesicoureteral reflux status pot Cohen’s procedure about 18 years ago, she presented with frequent urination and right flank pain for 1 week then fever with chills attacked for 3 days. Due to persisted symptoms, she visited emergency department. Laboratory data revealed severe leukocytosis with left shift and elevated creatinine. Urinalysis showed pyuria, microscopic hematuria and bacteriuria and urine culture yielded E. coli. Abdominal computed tomography showed right renal arteriovenous fistula, multifocal right pyelonephritis, and suspect early abscess changes at lower pole. Then transcatheter arterial embolization with coil was performed after empirical antibiotics and fluid resuscitation treatment. The symptoms subsided after the operation. Currently, the patient was following-up in our outpatient department.