A case of renal arteriovenous fistula between the main renal artery and interlobar vein diagnosed 25 years after percutaneous renal biopsy was presented. A 62-year-old female was referred to a urologist with dilatation of the left renal pyelocalyceal system diagnosed after abdominal ultrasonography, while intravenous urography did not confirm that finding. Historically, she underwent renal biopsy 25 years ago without any complication. Her hypertension was well controlled during the last 10 years, although three antihypertensive drugs with occasional additional diuretics were necessary during the last 6 months. Color Duplex Ultrasonography, arteriography and Multi-Slice Computed Tomography revealed the presence of renal arteriovenous fistula between the main renal artery and interlobar vein, as well as severe dilatation of all interlobar veins, renal, ovarian and adrenal vein on the left side. Urological and vascular surgeons operated to ligate the fistula and preserve the kidney. However, it was not possible to reach the fistula inside the kidney and nephrectomy was performed.
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