End stage renal disease caused by thromboangiitis obliterans: a case report.
BACKGROUND
Thromboangiitis obliterans or Buerger's disease is a nonatherosclerotic, segmental, inflammatory vasculitis that is strongly associated with tobacco products and commonly affects the small- and medium-sized arteries of the upper and lower extremities. However, the disease can, rarely, involve large central or visceral arteries. We report here the case of end stage renal disease due to renal artery thrombosis caused by thromboangiitis obliterans.


METHODS
A 51-year-old Korean man who had previously required amputation of both great toes due to thromboangiitis obliterans presented with left flank pain and oliguria. Both his renal arteries were occluded on contrast-enhanced abdominal computed tomography and abdominal angiography. He also had abdominal angina. He had no risk factor of thromboembolism from cardiac origin, atherosclerosis except for tobacco abuse, collagen diseases or hypercoagulable disorders. Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.


CONCLUSIONS
Renal failure due to renal artery thrombosis and mesenteric ischemia represents an unusual manifestation of thromboangiitis obliterans. But once it occurs, it can be life-threatening. When we care for a patient with thromboangiitis obliterans, we should pay attention to this rare disease course, and encourage cessation of the smoking of tobacco products.
Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. yhj0927@kyuh.ac.kr.
Hyo-Jin
HJ
Yun
Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. athlonpu@nate.com.
Dong-Il
DI
Kim
Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. dlrudgh@kyuh.ac.kr.
Kyung-Ho
KH
Lee
Department of Radiology, Konyang University College of Medicine, Daejeon, South Korea. ecoizm@hanmail.net.
Seong-Joo
SJ
Lim
Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. hwangwm@kyuh.ac.kr.
Won-Min
WM
Hwang
Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. sryun@kyuh.ac.kr.
Sung-Ro
SR
Yun
Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. sehei@hanmail.net.|Konyang University Myunggok Medical Research Institute, Daejeon, South Korea. sehei@hanmail.net.
Se-Hee
SH
Yoon
D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging; D006435:Renal Dialysis; D013919:Thromboangiitis Obliterans / Q000150:complications*; D014057:Tomography, X-Ray Computed