Renal Artery Embolism

Abstract

Renal artery embolism was first described in 1940, but it is only recently becoming recognized as a clinically significant entity. Although relatively uncommon, it is clearly responsible for considerable morbidity in patients who experience it. The pathogenesis is typically related to cardiac thrombus formation with subsequent embolization, although other etiologies have been described. The authors present a case report followed by a review of the literature to highlight the clinical characteristics of this phenomena. Presentation, diagnostics, and treatment options will be reviewed with the aim of increasing awareness of renal artery embolism. As clinicians become more familiar with this condition, they will be more likely to consider it as a possible diagnosis in patients with a typical presentation. This will hopefully lead to improved care through prompt diagnosis and treatment, particularly as one treatment option may be time sensitive.

A pain in the back

“…Renal infarction is most commonly caused by thromboembolism or in situ thrombosis,1 which makes atrial fibrillation a substantial risk factor for renal artery embolism 2. It has been reported that 48% of patients with renal infarction have atrial fibrillation 1…”

“…Diagnosis is delayed or missed in more than 50% of patients because the common presenting symptoms of renal infarction include acute onset abdominal, flank, or back pain; all of which are also suggestive of more common conditions such as pyelonephritis or nephrolithiasis 12. Other clinical manifestations of renal infarction can include haematuria, proteinuria, fever, and leucocytosis; which are, again, features of more common conditions 3…”

Acute Kidney Infarction Secondary to Intracardiac Thrombus Embolization in a Patient with Ischemic Dilated Cardiomyopathy

“…However, the choice of optimal treatment approach is still controversial. In the case of early diagnosis of renal infarction, both systemic fibrinolysis and/or surgical embolectomy can be recommended, especially in cases of bilateral occlusion or when a solitary functional kidney is affected [10,11]. Due to late admission and one kidney being affected in our patient, long-term infusion of heparin was considered optimal, led to full recovery and prevented further embolic events.…”

Renal Artery Embolism as Differential Diagnosis of Nephrocolicae

“…Renal artery embolism is a rare event, mostly seen in patients 60 to 80 years old, with certain predisposing risk factors for tromboembolism, dominantly with underlying cardiovascular disease including atrial fibrillation, rheumatic heart disease, cardiac heart failure, arterial hypertension and general atherosclerosis [1][2][3][4][5].…”

“…Contrast enhanced CT is considered to be a gold standard for diagnosis of renal artery embolism in the emergency department [1,2,3,5] Treatment options are early anticoagulation therapy and trombolytic therapy with streptokinase or tissue plasminogen activator preferably in early stage 90-180 minutes from onset [4,5]. Medicamentous choice as a first line of treatment is more favourable than surgical therapy that is preferred in patients with solitary kidney or bilateral emboli [5,7].…”