Pediatrics & Therapeutics
Open Access

Pediatric Traumatic Renal Artery Thrombosis Possibilities

Joseph Gigante^{* *}Correspondence: Joseph Gigante, Department of Pediatrics, Vanderbilt University, Nashville, USA, Email:

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Description

Unusual damage to the abdomen caused by forceful trauma includes renal artery thrombosis (RAT). Renal artery thrombosis is an uncommon complication that affects less than 1% of transplants. The kidney usually loses function as a result. Acute arterial thrombosis can happen during surgery or in the initial few days or weeks following a transplant. Although hyper acute rejection and a procoagulant condition are potential causes, technical errors in the anastomosis of tiny or atheromatous arteries account for the majority of cases. Sutures must be inserted through all layers of the vessel walls to prevent an intimal flap, and the vessels must not be under strain for the vascular anastomosis to be successful. Additionally, there must be a smooth transition between the two endothelial surfaces. Vascular adventitia must be kept out of the anastomosis lumen because it is thrombogenic. Atherosclerosis, chronic hypotension, volume depletion (such as diarrhea or excessive preoperative dialysis), and prothrombotic conditions, such as diabetes, all raise the risk of renal artery thrombosis.

Sudden anuria is a symptom of renal arterial thrombosis, and other possible diagnoses include dehydration, acute tubular necrosis, blocked urinary catheters, and urologic complications. Making this diagnosis requires a high degree of suspicion, especially in the initial postoperative period. The only worthwhile test is an urgent duplex ultrasound scan, but if the diagnosis is taken seriously, the only way to save the transplant is to reexamine it very away in the hopes that a therapeutic cause will be identified. The transplanted kidney has a limited probability of survival unless acute arterial thrombosis develops during surgery. However, in order to prevent the development of sepsis in a necrotic graft, a potentially deadly consequence, acutely thrombosed grafts must be investigated and removed.

Young guys are more likely to develop RAT, and most commonly after significant blunt trauma. The right renal artery may be compressed or stretched as a result of the abdominal contents and vertebral bodies, which can result in intimal damage and the formation of thrombosis. This is assumed to be the cause of renal artery thrombosis. Unilateral left RAT is more frequent than right or bilateral RAT. Within the last 20 years, there have been few descriptions of traumatic RAT in children.

It has been shown that older adult patients frequently have reduced renal function and survivability, particularly when they have bilateral artery damage. Ischemia time for salvage is roughly 8 hours, and no salvage is possible after 20 hours. Results can include maintained renal function, high blood pressure, acute kidney damage and/or failure, dependency on dialysis, renal transplantation, and/or death. Non-operative supportive treatment, revascularization using both traditional open procedures and more modern endovascular ones, nephrectomy for non-viable kidneys to prevent further malignant hypertension, and auto-transplantation are all included in the management of RAT. Due to the low number of pediatric case reports that exist and their predominance in older adolescents, pediatric traumatic RAT outcomes and management are still incompletely understood, particularly in younger pediatric patients. Because adult and pediatric populations differ in their propensity for hypertension, coagulopathy, and renal damage, drawing conclusions about RAT outcomes from adult groups is probably not suitable. The kidney is 50% completely and 50% partially devascularized as a result of RAT.