Acute kidney injury and malignant hypertension caused by occlusive radiation vasculopathy

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A 46 year old woman who presented with seizures, bilateral papillo-oedema, and blood pressure of 250/140 mm Hg was diagnosed with malignant hypertension. Eight years earlier she had received pelvic radiotherapy for cervical cancer. Blood tests showed severe acute kidney injury (creatinine 477 µmol/L), and urinary tract imaging found that the kidneys had shrunk from 9.5 cm to 7.5 cm over the preceding four months. Magnetic resonance angiography showed complete occlusion of the infrarenal abdominal aorta (large arrow) as well as the right accessory and left renal arteries, with severe ostial stenosis of the right main renal artery (small arrowhead)⇑. These findings were consistent with occlusive vasculopathy secondary to radiotherapy. She was referred for revascularisation.