An Autopsy Case of Nonocclusive Mesenteric Ischemia with Bilateral Renal Artery Vasoconstriction

Patient: Male, 84-year-old Final Diagnosis: Bilateral renal artery vasoconstriction • nonocclusive mesenteric ischemia Symptoms: Disturbance of consciousness Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Nephrology OBJECTIVE: Unknown etiology BACKGROUND: Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disease. We present the first case to indicate an association between NOMI and renal infarction caused by renal artery vasoconstriction. CASE REPORT: An 84-year-old Japanese man with no relevant past medical history was evaluated in the Emergency Department for disturbance of consciousness. The patient had a consciousness level of E(1)V(1)M(4) on the Glasgow Coma Scale, temperature of 29.4°C, blood pressure of 90/40 mmHg, regular pulse rate of 48 beats/min, oxygen saturation of 72% while breathing ambient air, abdominal distention, and abdominal tenderness with peritoneal signs. His hemoglobin levels were 3.6 g/dL, blood urea nitrogen per creatinine 54/1.12 mg/dL, plasma glucose 10 mg/dL, and lactate 12.5 mmol/L. Enhanced computed tomography revealed a dilated and distended large transverse colon, spotted poorly enhanced areas in the bilateral kidneys, and poor contrast enhancement of the bilateral renal arteries. The patient died 48 h after admission due to multiple organ failure. An autopsy revealed dappled hemostasis and ischemia in the transverse colon and bilateral kidneys, with no thrombotic infarction in the superior mesenteric artery and/or bilateral renal arteries. We diagnosed NOMI with acute renal tubular necrosis caused by vasoconstriction of the bilateral renal arteries. CONCLUSIONS: NOMI can occur simultaneously with renal vasoconstriction, suggesting that NOMI and renal artery vasoconstriction may share mechanisms. This case demonstrates that when enhanced computed tomography shows nonenhancing parenchymal regions in both kidneys, clinicians should check for renal artery vasoconstriction and the life-threatening disease of NOMI.