Case Presentation: Spontaneous renal artery dissection (SRAD) is a rare disorder that has been reported to occur in middle-aged men. It often presents similar to nephrolithiasis, making it’s presentation non-specific and easily missed. Including SRAD in the differential for renal colic type-pain is important to decrease morbidity and improve the chance of renal recovery.
Discussion: A 50-year-old male with a significant past medical history of bilateral nephrolithiasis and well-controlled hypertension presented with sudden, severe, and cramping left-sided abdominal pain radiating to his groin, associated with hematuria. This episode of renal colic was distinct from ones in the past, including nephrolithiasis. At the time of presentation, kidney function was within normal limits. CTA of abdomen/pelvis identified a focal dissection within a branch of the left renal artery, thought to be due to uncontrolled hypertension. Throughout the hospital course, there was no increase in creatinine. He was hemodynamically stable and did not require urgent surgical stenting or angioembolization. The patient was started on anticoagulation and beta blockers in addition to his home medications to control his blood pressure. Upon discharge, the patient was asymptomatic and was scheduled for a follow up with urology.
Conclusions: It is important to recognize SRAD as a differential diagnosis for renal colic type pain and obtain CTA imaging to rule it out. In patients with severe dissections that cause hemodynamic instability, immediate surgical action is necessary to salvage the kidney. Thus, early diagnosis of SRAD is important for timely intervention and to prevent irreversible renal injury.