Acute Renal Embolism

Abstract

Acute renal embolus is rarely reported in the medical literature; thus, accurate data regarding presentation, laboratory tests, diagnostic techniques, and treatment are lacking. To better define this condition, we examined the medical records of all patients admitted to Kaplan Medical Center and Sheba Medical Center in central Israel from 1984 to 2002 who had a diagnosis of renal infarction and atrial fibrillation. We noted demographic, clinical, and laboratory parameters; method of diagnosis; treatment received; and patient outcome. We identified 44 cases of renal embolus: 23 females and 21 males, with an average age of 69.5 +/- 12.6 years. Thirty (68%) patients had abdominal pain, and 6 (14%) had a previous embolic event. Nine patients were being treated with warfarin on admission, 6 (66%) of whom had an international normalized ratio (INR) < 1.8. Hematuria was present in 21/39 (54%), and 41 (93%) patients had a serum lactate dehydrogenase (LDH) level > 400 U/dL. The mean LDH was 1100 +/- 985 U/dL. Diagnostic techniques included renal isotope scan, which was abnormal in 36/37 cases (97%); contrast-enhanced computed tomography (CT) scan, which was diagnostic in 12/15 cases (80%); and ultrasound, which was positive in only 3/27 cases (11%). Angiography was positive in 10/10 cases (100%). Twenty-three (61%) of 38 patients had normal renal function on follow-up. The 30-day mortality was 11.4%. Renal embolus was diagnosed mainly in patients aged more than 60 years, some of whom had a previous embolic event. Most of those receiving anticoagulant therapy had a subtherapeutic INR. Abdominal pain was common, as well as hematuria and an elevated LDH. These patients are at risk of subsequent embolic events to other organs. The most sensitive diagnostic technique in this population is a renal isotope scan, but contrast-enhanced CT scan requires further assessment.

Thromboembolism as a Cause of Renal Artery Occlusion and Acute Kidney Injury: The Recovery of Kidney Function after Two Weeks

“…The reported incidence of renal thromboembolism in patients with atrial fibrillation was 2% in a series of almost 30,000 patients followed for up to 13 years [4]. Other significant cardiac disorders include ischemic heart disease, cardiomyopathy and valvular disease as in our case [5, 6]. Furthermore, valvular vegetations in infective endocarditis, rarely tumor, and paradoxical embolism through a patent foramen ovale are potential embolic sources.…”

A pain in the back

“…In a series of 44 patients with atrial fibrillation, renal infarct was diagnosed in 80% with contrast enhanced computed tomography only, while just 11% were diagnosed by renal ultrasound scan 3. Typically, the findings on computed tomography of acute infarcts are wedge shaped areas of low attenuation with normal appearances of the remainder of the kidney (fig 2).…”

Induction of Tolerance to Warfarin after Anaphylaxis with a Desensitization Protocol

“…Persons with acute renal infarction are known to have a high risk of recurrent thromboembolic phenomena with a 30-day mortality rate of 11% [3]. Adequate anti-coagulation is mandatory to restore renal function and decrease short- and long-term morbidity and mortality [4].…”