Congenital Renal Arteriovenous Malformation Presenting With Gross Hematuria After a Routine Jog: A Case Report

Erin L Dames; Lay Guat Ng; Kiang Hiong Tay


J Med Case Reports. 2014;8(65) 

In This Article


Congenital AVM is an uncommon abnormal communication between an artery and a vein that causes vascular shunting; while some communicate via small arteriovenous conduit, others are joined via smaller capillary-like pathway or glomus channels. Some genetic vascular diseases, such as hereditary hemorrhagic telangectasia are associated with AVM in multiple anatomic sites, including the brain and brainstem, spine, lung and liver.[10] These disorders can be discovered incidentally or during workup for an unexpected clinical event (such as intracranial hemorrhage in the brain or dyspnea in the lungs[11]). However, lack of vascular differentiation during angiogenesis can also give rise to AVM in other visceral organs such as the kidneys along with more superficial sites, such as the scalp, face and limbs.[11,12]

Renal AVMs are a rare entity and only a limited number of cases have been described in the literature. In the case reports of note, presentation can vary between subtle incidental findings to severe hypertension, congestive heart failure and massive hematuria.[1] The patient in this case report presented with exercise-induced hematuria; an atypical presentation for congenital renal AVM. Most common causes of hematuria such as calculi, infection and neoplasms were considered as diagnosis in the initial stages. However, our patient's episodic relapses of gross hematuria prompted further radiologic investigation for the less common vascular anomalies.

In light of the myriad of presentations and potential morbidity of such an anomaly, it is important to ascertain a definitive diagnosis and initiate treatment as necessary. For incidentally diagnosed AVMs, endovascular therapy has proven effective in asymptomatic patients or patients that are stable on presentation. However, surgical treatment remains a reasonable choice in unstable patients or in patients whose renovascular anatomy is not favorable for endovascular treatment.