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A previously healthy 31-year-old man experienced a sudden onset of severe left loin pain radiating into the left lower abdomen during a side-movement, while performing a workout of the abdominal muscles in a fitness club. He collapsed and was immediately brought to our emergency department. Vital signs were blood pressure 130/75 mmHg, heart rate 64/min, height 185 cm and weight 85 kg. The clinical examination was unremarkable. Relevant laboratory parameters were a serum creatinine of 1.2 mg/dL, blood–urea nitrogen of 15 mg/dL, creatinine kinase of 24 IU/L (25◦C) and a normal urinalysis. Abdominal CT revealed the absence of perfusion of the lower and middle pole of the left kidney, corresponding to an 80% perfusion deficit (Figure 1A). Subsequent angiography demonstrated a dissection and thrombotic occlusion of the left renal artery (Figure 1B). Multi-step local lysis was performed within 6 h and on the following day, using 7 mg of recombinant tissue–plasminogen activator (rt-PA), respectively. As estimated by final angiography, perfusion could be essentially restored (Figure 1C). On Day 2, LDH rose to 1950 U/L (25◦C), demonstrating tissue damage, and serum creatinine was 1.5 mg/dL but reached a steady state at 1.3 mg/dL during the next days. Subsequently, blood pressure remained normal and the patient was discharged on oral phenprocoumon for 6 months without antihypertensive medication. At 6-month follow-up, blood pressure was 110/75 mmHg, serum creatinine was 1.0 mg/dl and creatinine clearance was 95 mL/min. Doppler ultrasonography showed a renal arterial resistive-index of 0.6 bilaterally, indicating the absence of re-occlusion or re-stenosis. The lysed kidney had shrunk by 2 cm in length but ∼50% of its function was

The rare event of exercise-induced dissection of the renal artery: successful long-term treatment by localized lysis