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OP3: Renal AVM Mimicking Glomerular Disease.
- 1. Renal Arterio-Venous Malformation Mimicking as Glomerular Disease Presenter – Karan Saraf, DM Resident Co-Authors – Ravindra P, Shankar P, Dharshan R, Ashwin R, Mohit M, Srikanth P, Sindhu K, Srinivas S Institution – Kasturba Medical College, Manipal
- 2. INTRODUCTION Gross hematuria can be a diagnostic challenge for physician Renal AVM have an incidence of 0.04% Here is an interesting case of hematuria, with a twist in the tale, where percutaneous intervention was done to successfully treat the condition
- 3. Case 19 year, Male, Nil Premorbid Presented in Feb, 2015 with gross hematuria Clinical examination – Normal
- 4. Post procedure, hematuria resolved over next 2 days and patient has remained symptoms free till last follow up
- 5. Thank You
Editor's Notes
- Introduction – Gross hematuria can be caused due to a plethora of conditions ranging from primary glomerulopathies to rare conditions like renal vascular pathological processes such as renal artery aneurysm, nutcracker syndrome and renal arteriovenous malformations (AVM). Hematuria can thus be a diagnostic challenge for the physician. Renal AVM’s have an incidence of about 0.04%. We present an interesting case of hematuria where initial investigations suggested a primary glomerular pathology but eventually diagnosed as renal arteriovenous malformation. Percutaneous endovascular coiling was done to successfully treat the condition. Case – A 19 year old male, presented in Feb 2015 with sudden onset, painless, gross hematuria. There were no skin or tongue angiomas, no other bleeding diathesis on clinical examination. Investigations showed Hemoglobin of 9.5gm/dl, normal renal functions, normal coagulation profile. Urinalysis showed 2+ protein with numerous RBC. 24 hour proteinuria was 1.1 grams, C3/C4 normal and ANA/ANCA negative. Ultrasonography was normal, urine for malignant cells negative, haemoglobin lectrophoresis negative. A left renal biopsy was done on 25th Feb 2015, which showed normal glomerular morphology. EM showed mesangial proliferation (?IgA Nephropathy). Patient was started on steroids and by June 2015, proteinuria decreased to 240mg/day, however hematuria persisted. CT angiography done was normal. Consequently, a DSA was done which was also reported as normal. He was continued on conservative management. Hematuria increased since December 2015 requiring recurrent blood transfusions and haemoglobin dropping to 3.5gm/dl. 24 hour proteinuria increased to 1.7 grams/day. Cystoscopy revealed clots in the bladder, efflux of blood form right ureteric orifice and bifid right renal pelvis. Therefore, a repeat renal angiography was done with support of interventional radiologist, in May 2016, which showed a focal area of small additional vascular channels adjacent to the right mid pole artery, likely representing small AVM. Endovascular coiling using 4 Fr Glide cobra cath was done. Post procedure, hematuria resolved over next 2 days and patient has remained symptoms free till last follow up
- A 19 year old male, presented in Feb 2015 with sudden onset, painless, gross hematuria. There were no skin or tongue angiomas, no other bleeding diathesis on clinical examination. Investigations showed Hemoglobin of 9.5gm/dl, normal renal functions, normal coagulation profile. Urinalysis showed 2+ protein with numerous RBC. 24 hour proteinuria was 1.1 grams, C3/C4 normal and ANA/ANCA negative. Ultrasonography was normal, urine for malignant cells negative, haemoglobin lectrophoresis negative. A left renal biopsy was done on 25th Feb 2015, which showed normal glomerular morphology. EM showed mesangial proliferation (?IgA Nephropathy). Patient was started on steroids and by June 2015, proteinuria decreased to 240mg/day, however hematuria persisted. CT angiography done was normal. Consequently, a DSA was done which was also reported as normal. He was continued on conservative management. Hematuria increased since December 2015 requiring recurrent blood transfusions and haemoglobin dropping to 3.5gm/dl. 24 hour proteinuria increased to 1.7 grams/day. Cystoscopy revealed clots in the bladder, efflux of blood form right ureteric orifice and bifid right renal pelvis. Therefore, a repeat renal angiography was done with support of interventional radiologist, in May 2016, which showed a focal area of small additional vascular channels adjacent to the right mid pole artery, likely representing small AVM. Endovascular coiling using 4 Fr Glide cobra cath was done. Post procedure, hematuria resolved over next 2 days and patient has remained symptoms free till last follow up