title: An unusual case of hematuria in a young female: renal artery embolism, mitral stenosis, and sinus rhythm.
abstract: Renal artery embolism (RAE) is an uncommon entity that is most often secondary to a cardiac source. Most reported cases have been in patients with underlying atrial fibrillation (AF), and occurrence of RAE, especially in patients with valvular heart disease, and sinus rhythm is very rare. We describe an unusual case of a young female who presented with sudden onset right flank pain, vomiting, anorexia, and hematuria, and was found to have thrombotic occlusion of the distal right renal artery. Although she denied any previous cardiac history, detailed cardiovascular examination revealed the presence of severe rheumatic mitral stenosis without any evidence of AF or left atrial clot. She was initially managed conservatively using low molecular weight heparin followed by oral anticoagulation with resolution of symptoms. A successful balloon mitral valvotomy was performed six weeks later. The patient is asymptomatic at her last follow-up of six months with preserved renal function. In symptomatic patients, clinicians need to consider the possibility of RAE even in patients of valvular heart disease with underlying sinus rhythm. Appropriate management of the underlying cardiac condition is imperative since embolism may be recurrent leading to compromise of renal function, if left untreated.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D063126:Balloon Valvuloplasty; D017548:Echocardiography, Transesophageal; D005260:Female; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants