Acute renal infarction: a single center experience

Abstract

Background Acute renal infarction is a rare condition whose diagnosis is often delayed. Major risk factors include atrial fibrillation, valvular or ischemic heart disease, renal artery thrombosis/dissection and coagulopathy. MethodsWe reviewed the medical records of 18 patients admitted to our Nephrology Department between 1999 and 2015 for acute renal infarction diagnosed by computed tomography. Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed in some patients during follow-up to assess parenchymal lesions and estimate differential kidney function. ResultsMean age was 59.8 years. Major associated risk factors included hypertension (44 %), obesity (33 %), atrial fibrillation (28 %), peripheral vascular disease (17 %), smoking (17 %), prior thromboembolic event (11 %), diabetes (11 %), estroprogestinic therapy (11 %). Seventy-two percent of patients presented with flank pain. Mean serum creatinine was 1.2 ± 0.6 mg/dl. Acute kidney injury occurred as the initial manifestation in two patients. Patients were managed conservatively, with low molecular weight heparin (83 %) or aspirin (11 %). At the end of follow-up serum creatinine was 1.1 ± 0.3 mg/dl; one patient remained on chronic hemodialysis. 58 % of patients who underwent renal scintigraphy after a median of 8 months had a reduced contribution of the previously affected kidney to total renal function. ConclusionRisk factors associated with the development of chronic kidney disease following renal infarction are unknown. In our subjects, renal function remained stable in all but one patient who developed end stage renal disease. Further studies should focus on etiology and evolution of kidney function in patients with acute renal infarction. IntroductionAcute renal infarction, due to an abrupt interruption of renal arterial flow, is a rare condition with an estimated incidence of 0.004-0.007 % in the Emergency Department setting [1,2]. Non-specific clinical presentation mimicking other pathologic states (e.g. urolithiasis, acute pyelonephritis, other acute abdominal diseases) often causes a delay in the diagnosis, which may increase the risk of impaired renal failure [3][4][5]. Radiologic diagnosis of renal infarction is based on enhanced contrast computed tomography (CT), which typically indicates the presence of a wedge-shaped hypodense area in the peripheral region [2]. Major risk factors for renal infarction include atrial fibrillation, valvular or ischemic heart disease, renal artery thrombosis/dissection and coagulopathy. Etiology remains unknown in many cases [4,6,7]. We describe the clinical and radiological characteristics and renal prognosis of 18 patients with acute renal infarction.

A rare cause of acute abdominal pain

“…The gold standard for the diagnosis is angiography, and the most commonly used method is contrast-enhanced computed tomography. 6 Renal artery thrombosis could be associated with other pathologic conditions, 5,7 but no links between liver transplantation and renal thrombosis have been found. We speculate that the long immunosuppressive therapy with Tacrolimus that transplanted patients have to assume could predispose to renal artery thrombosis, but no evidence has been found in literature.…”

A Rare Cause of Acute Kidney Injury in a Female Patient with Breast Cancer Presenting as Renal Colic

“…However, its true incidence appears to be higher since a great proportion of cases are discovered incidentally at the autopsy [ 1 ]. The main cause of acute renal infarction is reported to be atrial fibrillation [ 12 , 13 ], with approximately 2 percent of the patients being predisposed to have a renal thromboembolic event during the natural history of the disease [ 14 ]. Dilated cardiomyopathy [ 4 , 5 , 15 ], infective endocarditis, or thrombi of atheroma from the suprarenal aorta [ 1 ] are other potential sources of emboli to a renal artery.…”

Infarto renal: revisión sistemática sobre síntomas de sospecha clínica y repercusión sobre función renal

“…Con respecto al impacto en la función renal, encontramos que se identificó la injuria renal aguda, según la clasificación RIFLE en las series de Yang (32) , Nagasawa (33) y Rhee (26), la clasificación AKIN fue utilizada por Mesiano (34) y la clasificación KDIGO por Bae (4) , Oh (3) y Kwon (35) . En la serie de Ongun (36) y Domanovits (37) se define por un aumento de la creatinina por encima de 1,3 mg/dl.…”