Effect of local low-dose thrombolysis on clinical outcome in acute embolic renal artery occlusion.

Blum, Ulrike; Billmann, P; Krause, Trudy Millard; Gabelmann, Andreas; Keller, E.; Moser, Elizabeth A. S.; Langer, M.

doi:10.1148/radiology.189.2.8210388

Cited by 95 publications

(89 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5,9 Atrial fibrillation is noted to be the biggest risk factor, as in our case. Another two causes are myocardial infarction and rheumatic mitral stenosis.…”

Section: Treatmentsupporting

confidence: 58%

“…The risk of bleeding on thrombolytic therapy is minimized by local intra-arterial infusion of a thrombolytic agent. 9 Reperfusion therapy should only be considered in a patient who does not have atrophic kidneys or a history of prolonged ischemia. In the majority of patients with thromboembolic disease, renal infarction is treated with anticoagulation, but many patients have a clear indication, such as atrial fibrillation.…”

Section: Laboratory Manifestationsmentioning

confidence: 99%

See 1 more Smart Citation

Renal infarction

Saeed¹

2012

IJNRD

View full text Add to dashboard Cite

Abstract:Renal infarction is an underdiagnosed and under-reported phenomenon, and needs to be diagnosed rapidly to prevent permanent loss of renal function. Renal infarction should be considered in the initial differential diagnosis of nephrolithiasis and pyelonephritis. It is often mistaken for more benign pathology and is worthwhile reviewing and reporting. Keywords: renal infarction, diagnosis, atrial fibrillation Case reportA 77-year-old woman was admitted with severe epigastric pain radiating to the back, bloody diarrhea, and vomiting, which started a night prior to admission. She described her abdominal pain as being similar to cholecystitis pain which she had suffered many years ago. She had a history of chronic atrial fibrillation and was off warfarin pending eye surgery. There was no history of recent travel, nonsteroidal anti-inflammatory drug use, or any dietary changes. She denied any history of alcohol or recreational drug use. Her other relevant past medical history included a stroke in 1994, type 2 diabetes, hypertension, dyslipidemia, gastroesophageal reflux disease, and a history of stomach ulcers with gastrointestinal bleeding (diffuse hemorrhagic gastritis with Helicobacter pylori in 1999). Medications on admission included hydrochlorothiazide, metformin, gliclazide, amlodipine, digoxin, candesartan, metoprolol, spironolactone, atorvastatin, and eye drops.Physical examination revealed a blood pressure of 189/94 mmHg and a heart rate of 85 beats per minute, irregular. She was afebrile, with normal saturation. She had diffuse abdominal tenderness, but no rebound tenderness or guarding. She had melena and a hemoccult test was positive.Laboratory studies were done on admission, and showed amylase 365 (20-160) U/L, lipase 221 (8-78) U/L, white blood count 28.9 (4.8-10.8) × 10 9 /L, absolute neutrophil count 27.5 (2-7.5) × 10 9 /L, and lactate dehydrogenase 485 (115-220) U/L (Table 1). Electrolytes, renal function, and liver function were normal. Albumin was 43 (32-45) g/L and INR was 1.25 (0.8-1.20). The digoxin level was 0.79 (0.64-2.56) nmol/L. Urine analysis was unremarkable except for 2+ glucose, positive occult blood, and 10-20 red blood cells per high powered field in the urine. A 24-hour urinary protein was 0.19 (0.0-0.15) g/day and creatinine clearance was 67 mL per minute, with a daily volume of 2750 mL.On admission, a series of abdominal x-rays and a computed tomography (CT) scan were ordered. The abdominal-rays showed a nonspecific gas pattern. No fluid level was noted. A chest x-ray showed cardiomegaly with calcification and unfolding of the thoracic aorta. Abdominal CT showed no signs of pancreatitis or stones. An 8 mm focal area of infarction was noted in the left kidney as well as a small focal infarction in the right kidney, which indicated extensive atherosclerosis of the superior mesenteric artery. No evidence of ischemic bowel or perforation was noted. There were scattered diverticuli but no signs of diverticulitis. Air space disease was noted at the left lung base.A hypercoagula...

show abstract

“…5,9 Atrial fibrillation is noted to be the biggest risk factor, as in our case. Another two causes are myocardial infarction and rheumatic mitral stenosis.…”

Section: Treatmentsupporting

confidence: 58%

Section: Laboratory Manifestationsmentioning

confidence: 99%

Renal infarction

Saeed¹

2012

IJNRD

View full text Add to dashboard Cite

show abstract

“…More than 95% of patients have a history of one or more risk factors for thromboembolism. Atrial fibrillation, valvular heart disease, ischemic heart disease, inherited or acquired coagulopathies, and a previous history of thromboembolic events are the major predisposing factors [1][2][3][4]6] Less commonly, idiopathic cases of acute renal infarction in patients with no preexisting disorders have also been reported [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…Medical management with local low-dose, intra-arterial thrombolysis or systemic anticoagulation is generally preferred over surgical embolectomy, which is usually reserved for bilateral disease or involvement of a solitary kidney [2,4,6,7]. However, recovery of renal function only usually occurs if these interventions are employed within 90-180 minutes of symptom onset, which represents the ischemic tolerance of normal kidney [4].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function [1][2][3][4]. We report a case of acute renal infarction following an acute myocardial infarction in a patient who presented to us with acute abdominal pain mimicking appendicitis.…”

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

Acute Abdomen as an Unusual Presentation of Myocardial Infarction

Nivargi¹,

Makhale²,

Kulkarni³

2017

J Cardiovasc Dis Diagn

View full text Add to dashboard Cite

A 29 years old male patient, chronic smoker with no history of diabetes, hypertension, ischemic heart disease or renal dysfunction was admitted in our hospital with complaints of acute onset pain in the right iliac fossa radiating to the umbilical region associated with multiple episodes of vomiting without hematemesis. Patient was clinically diagnosed to have acute appendicitis and treated for the same.Routine electrocardiogram done in the surgical intensive care unit suggested an acute anterior wall ST segment elevation myocardial infarction for which the patient was thrombolysed. Patients symptoms immediately subsided. Coronary and renal angiogram showed a recanalized left anterior descending artery with right renal artery thrombus. The acute renal infarction was responsible for his acute abdomen. A transient left ventricular clot produced by the stunned myocardium was held responsible for the above events.

show abstract