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Acute renal failure secondary to massive arteriovenous fistula between aorta and iliac vein.

Extrarenal arterovenous fistula has not been described as a cause of acute renal failure. The present case report describes a 64-year-old male who had acute renal failure hemodynamically mediated by a high output arteriovenous fistula which suddenly appeared between the aorta at its bifurcation and the left iliac vein at its origin (fig. 1). The patient was admitted to our hospital because of epigastric pain that appeared a few hours before admission. A pulsating mass in the umbilical area was present. An echographic examination showed an aneurysm of the infrarenal aorta which was 7.6 × 6.4 cm in diameter with thrombosis of its lumen and a false lumen of 2.5 cm. The iliac arteries were winding with an ectatic lumen of 1.3 cm. Tests performed on the first hospital day showed: BUN 56mg/dl (9.296 mmol/l); serum creatinine 5.2 mg/dl (459.68 mmol/l); CK 993 IU/1; AST 170 IU/1; ALT 105 IU/1; WBC 15.9×103/µl; PLT 177×103/µl. The patient acidosis, anuria and elevation of necrosis enzymes: AST CPK