Renal Artery Aneurysm - Symptoms, Diagnosis, and Treatment

What Is Aneurysm?

An aneurysm is an unusual bulge or enlarged wall of an artery caused by a weakened arterial wall. The enlargement in the arterial wall occurs when the blood passing through the artery forces the weekend part to balloon outwards. An aneurysm can happen in any blood vessel. They usually form in the aorta (blood vessels carrying blood from the heart), leg, belly, spleen, knees, intestine, and kidney. Signs and symptoms of the aneurysm vary with the type and location. Aneurysm occurring in the body and brain does not present any symptoms until they rupture. Aneurysms present near the surface of the body can show symptoms like swelling and pain.

What Are the Complications Caused by an Aneurysm?

• Stroke - It is a condition in which a part of the brain is affected by reduced blood supply, causing a condition called hypoxia (reduced blood supply).

• Internal Bleeding - Aneurysm can cause rupture of the blood vessels leading to uncontrolled bleeding.

• Aneurysm Rupture - When the aortic aneurysm ruptures, a fall in blood pressure with shortness of breath can occur, which can be life-threatening.

• Leaking Aneurysm - Blood can leak from the aneurysm without rupturing. This occurs when the weakened portion of the arterial wall becomes thin and can allow blood to pass through it. This blood is called ‘sentinel blood.’ The symptoms of a leaking aneurysm are the same as that of a ruptured aneurysm. This sentinel blood, if not treated, can lead to cerebral hemorrhage.

What Is Renal Artery Aneurysm?

Renal (kidney) arteries are the blood vessels that supply blood from the heart to the kidneys. A renal artery aneurysm (or kidney artery aneurysm) is the enlargement of this renal artery. A bulge forms in the weakened portion of the renal artery and can lead to double the diameter of the normal artery. Most of these aneurysms are rare and can be found during diagnostic tests performed for some other medical condition. Renal artery aneurysms can be caused by certain diseases, infection, congenital weakness in the walls of the arteries, and trauma causing damage to the arterial wall.

What Are the Symptoms of Renal Artery Aneurysm?

Generally, the renal artery aneurysm is asymptomatic with a diameter of less than 2 cm (centimeters). Aneurysms that are larger than 2 cm require medical attention as they have a high tendency to rupture. Such aneurysms can present symptoms such as:

• Pain - A tear in the artery wall can cause flank pain.

• Hypertension - It is an increase in blood pressure and can occur in most patients suffering from renal artery aneurysms.

• Hematuria - Bleeding can occur from the aneurysm leading to the presence of blood in the urine.

• Renal Infarction - Failure in the blood supply to a part of the kidney or a whole kidney can cause renal infarction. This can be caused when there is decreased blood supply due to obstruction or rupture of the blood vessels supplying it.

• Dissecting Aneurysm - It is caused by a tear in the inner layer of the renal artery wall, which can cause pain and blood in the urine.

• Reduced Kidney Function - Kidney impairment due to obstruction in the blood flow can occur due to aneurysms, blood clots, or kidney disease.

How to Diagnose Renal Artery Aneurysm?

Aneurysms are asymptomatic; therefore, they are found accidentally while diagnosing other conditions or symptoms.

• Renal Duplex Ultrasounds - Duplex ultrasound is a non-invasive technique to scan the blood vessels supplying the kidney. They can be used to diagnose any actual artery disease and the presence or absence of aneurysms or blood clots.

• Abdominal Radiographs - X-rays of the kidney to understand the size and location of the kidney can be done.

• Computed Tomography (CT) Angiogram Scan - It is an imaging technique that uses X-rays and a special dye. The dye is inserted intravenously, which then provides a detailed picture of the arteries. It is used to diagnose narrowed arteries or for the presence of any blockages.

• Arteriography - It is an imaging technique that uses X-rays and a special dye to evaluate the condition inside the arteries. It is done to evaluate renal vascular hypertension and the presence of other diseases.

• Intravenous Pyelography - It is an amazing technique that uses X-rays and contrast media to study structures like arteries, kidneys, ureters, and bladder.

• Magnetic Resonance Angiogram (MRA) - MRA is an imaging technique used to study the internal structures of the body. Magnetic resonance uses radio waves to study the structures of the renal arteries. The test provides results for the condition of the artery walls and blood flow. It can also detect narrowing of the arteries and any obstruction in the blood flow.

How to Treat Renal Artery Aneurysm?

• Aneurysms that are smaller in diameter and less than 1 cm do not require surgical intervention. Aneurysms larger than 2 cm require medical attention and need to be treated urgently. The treatment depends upon the size and location of the aneurysm.

• Frequent examination and observation are required for the growth and development of other complications associated with an aneurysm. An asymptomatic aneurysm may not present any symptoms, but there can be a risk of rupture and fistulization with an increase in size.

• Surgical intervention in larger aneurysms can cause a dissecting aneurysm, kidney ischemia, hypertension, aneurysms growing larger, and aneurysms causing severe symptoms. Aneurysm in the case of a pregnant woman needs to be treated earlier as there is a risk of rupture. Other symptoms can be treated by medication.

• Endovascular therapies also provide better results in adverse events. Surgical treatment may be necessary for women of childbearing age. Surgical reconstructions of renal artery aneurysms larger than 2 cm in diameter can provide sound and durable results.

• Adverse events occurring with renal artery aneurysms can be treated via medications. The specific treatment of renal artery aneurysms depends on the overall health, medical history, severity of the disease, and tolerance of medications or therapies.

• Prevention from forming an aneurysm can be achieved by incorporating daily exercise to boost blood circulation, quitting smoking or use of tobacco, and frequent six-month or annual check-ups should be done for early screening of aneurysm.

Conclusion

Renal artery aneurysms are uncommon. The urologist usually detects most renal artery aneurysms that are found accidentally while diagnosing other medical conditions or diseases. They are generally asymptomatic and do not require surgical intervention. The treatment of aneurysms depends on the presence of symptoms. Asymptomatic patients should be referred for elective repair, and patients with symptomatic conditions should be treated with further investigations and possible surgical intervention.