8 The mean age at diagnosis is age 60 years, occurs more commonly in men, and is primarily located on the right.2,5 RAAs can be either congenital or acquired. Congenital RAAs have been associated with autosomal dominant polycystic disease, fibromuscular dysplasia, and tuberous sclerosis.5 Congenital RAAs are frequently located at the bifurcation of the renal arteries and are typically of the fusiform type.1,4 Acquired etiologies include longstanding untreated hypertension, atherosclerosis, blunt7,9 and penetrating6 trauma, recent surgical manipulation (open, laparoscopic, and/or endovascular),11 angiomyolipomas, infectious (ie, mycotic),12 polyarteritis nodosa,2 malignancy, coagulopathy,

radiation, Inhibitors,research,lifescience,medical and/or cyclophosphamide use.2 Acquired RAAs have a highly variable Inhibitors,research,lifescience,medical location1,6 and size (1 to 10 cm), although most (> 90%) are smaller than 2 cm.5 The risk of rupture is thought to vary inversely with size, and most investigators agree that aneurysms larger than > 2 cm are more likely to undergo rupture.6 The rupture rate occurs in approximately 30% of cases, with mortality Inhibitors,research,lifescience,medical greater than 20%.4,6 RAAs are frequently asymptomatic, especially in children.1 Most RAAs are discovered on a workup for hypertension (55%), and are more frequently being discovered incidentally during unrelated abdominal

imaging (ie, radiography, color Doppler ultrasound, computed tomography [CT], MRI) or angiography.5 When patients do Inhibitors,research,lifescience,medical present with symptoms, they usually present with flank pain and hematuria that can range from mild microscopic hematuria to gross hemorrhage leading to hemodynamic instability.2,4,10,13 Ecchymosis, a palpable or pulsatile abdominal mass, and/or bruits are rare presenting symptoms.14 A Selleck Mdm2 inhibitor thorough history and physical examination

Inhibitors,research,lifescience,medical cannot be overemphasized, specifically addressing any previous history of trauma, as there can often be a substantial delay from months to years from the initial insult.9 Imaging is required to confirm the diagnosis of a RAA. In one series, only 66% of excretory urograms were diagnostic or suggestive of the presence of a renovascular lesion, whereas angiography was 100% diagnostic.2,4,10,14 Although angiography is the gold standard, perhaps the best noninvasive test to Suplatast tosilate evaluate location, size, structure, and relation to nearby organs is CT/MRA.6 In one study, MRA was able to distinguish between aneurismal-type malformations with a sensitivity, specificity, and accuracy of 78%, 100%, and 91%, respectively.15 Small cirsoid-type malformations (grade 1 = <2 cm) were not detected in 2 patients. Other imaging modalities that can give clues to the diagnosis include Doppler ultrasound, contrast-enhanced CT, and nuclear scintigraphy.8,10,12 Although most RAAs are small and asymptomatic, growth is unpredictable and complications may result as they enlarge.