Renal Arteriovenous Fistula Following Percutaneous Renal Biopsy

RENAL arteriovenous fistula is a rare complication of percutaneous renal biopsy, with only four cases previously reported. The purpose of the present communication is to draw attention to this complication and record a fifth case. Case Report The patient, a 29-year-old male, was first seen in the Outpatient Department of the Los Angeles County General Hospital on Feb. 19, 1961, with a stab wound of the neck. Blood pressure at that time was noted to be 200/120 mm Hg. A history was elicited of normotension while in the military service from 19S3 to 1956 and early in 1959, at the time of an insurance medical examination. The patient was first admitted to the Los Angeles County General Hospital on June 20, 1961, with shortness of breath, wheezing, and productive cough. He stated that he had been in good health until nine months prior to admission when he consulted his family doctor with complaints of dizziness, blurring vision, and mild occipital headaches. He was told that he had high blood pressure and was treated for such by his family physician. The patient stated that he felt so well after a period of a few months that he discontinued the medication. While in hospital an extensive work-up did not reveal a specific etiology for the hypertension. The patient was readmitted to the County Hospital in July 1962. At this time a translumbar aorto-gram revealed both the renal arteries and their peripheral branches to be normal. In August 1962 three attempts were made at percutaneous renal biopsy; in each instance insufficient tissue was obtained for diagnosis. In September 1962, a right renal biopsy was carried out under direct vision. This was interpreted by Dr. Hugh A. Edmondson, of the Department of Pathology, as “hyperplastic arteriolar sclerosis (malignant hypertension.)” The patient was again admitted on May 8, 1963, with shortness of breath and wheezing. He improved and was discharged to the Outpatient Clinic, but he was delinquent in keeping his Clinic appointments. He was readmitted on May 20, with recurrent shortness of breath and wheezing. The patient responded to routine therapy and at no time complained of paroxysmal nocturnal dyspnea or orthopnea. Physical examination was unremarkable except for hypertension. No abdominal bruits were heard at any time. Repeat aortography on June 6 demonstrated a left renal arteriovenous fistula. Cardiac catheterization on June 11 showed an aortic pressure of 225/145 mm Hg with a mean pressure of 165 mm Hg; a pulmonary artery pressure of 55/28 mm Hg with a mean pressure of 35 mm Hg; a cardiac output of 6.5 liters per minute at rest; a cardiac index of 3.2 liters per minute per square meter of body surface; oxygen saturations in the left renal vein of 86 per cent and in the right renal vein of 79 per cent.