Kidney nontumor / medical renal

Vascular disease

Hypertensive renal disease

Spontaneous renal artery dissection

Editorial Board Member: Maria Tretiakova, M.D., Ph.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Jian-Hua Qiao, M.D.

Last author update: 1 March 2017
Last staff update: 30 June 2022

Copyright: 2018-2023,, Inc.

PubMed search: Spontaneous renal artery dissection

Jian-Hua Qiao, M.D.
Page views in 2022: 271
Page views in 2023 to date: 181
Cite this page: Qiao JH. Spontaneous renal artery dissection. website. Accessed September 26th, 2023.
Definition / general
  • Spontaneous renal artery dissection is a rare entity with fewer than 200 cases reported in the literature
Essential features
  • SRAD is a rare condition and accurate clinical diagnosis is often delayed
    • Clinical presentation of SRAD is nonspecific, including hypertension, hematuria, flank pain or lower back pain as in renal colic
    • SRAD is more common in male patients
    • SRAD usually is unilateral but 10 - 15% of cases involve both renal arteries
    • The consequence of SRAD is renal hypoperfusion, severe hypertension, renal infarction and decreased or lost renal function
    • Treatment includes anticoagulation, revascularization and nephrectomy
  • Healthy men in fourth to sixth decade of life with 4:1 male to female ratio
  • Mostly involves one kidney; about 10 - 15% of cases have bilateral involvement
  • Renal vascular hypertension, renal insufficiency and renal infarction
Clinical features
  • Flank pain, severe hypertension and renal insufficiency
  • Abdominal CT with contrast and angiogram
  • Decreased renal function tests
Radiology description
  • CT scan often shows renal infarction, angiogram remains the definitive study (Rev Urol 2007;9:156)
Case reports
  • Anticoagulation, endovascular management (stenting or coiling) and nephrectomy
Gross description
  • Dilated renal artery at the hilar region of the affected kidney and variable sized renal infarction
Gross images

Contributed by Jian-Hua Qiao, M.D.

Various images

Microscopic (histologic) description
  • Renal artery dissection with elongated hematoma in renal artery wall, renal cortical ischemic infarction and renal papillae hemorrhagic infarction
Microscopic (histologic) images

Contributed by Jian-Hua Qiao, M.D.

Renal artery dissection

Renal cortex ischemic infarction

Renal papillae hemorrhagic infarction

Board review style question #1
All for the following statements about spontaneous renal artery dissection are correct, except

  1. Spontaneous renal artery dissection is a rare clinical condition
  2. The entity is more commonly seen in male patients
  3. Clinical presentation includes frank pain and hypertension
  4. Spontaneous renal artery dissection usually involves both renal arteries
Board review style answer #1
D. Spontaneous renal artery dissection usually involves both renal arteries. Spontaneous renal artery dissection usually involves one renal artery; bilateral disease is only encountered in 10 - 15% of SRAD cases.

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Reference: Spontaneous Renal Artery Dissection (SRAD)
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