Acute Renal Infarction: Clinical Characteristics of 17 Patients

Abstract

We analyzed the medical records of patients with an established diagnosis of acute renal infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male) who were admitted to our emergency department between May 1994 and January 1998 were diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction (0.007% of all patients). We screened the records of the 17 patients for a history with increased risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to be associated with acute renal infarction. A history with increased risk for thromboembolism with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9), and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of 17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14 (82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain, elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove acute renal infarction.

Renal Artery Embolism Diagnoed by Abdominal Ct and Successfully Managed Conservatively After Thirty-Six Hours: A Case Report.

“…Major risk factors for RAE include atrial fibrillation, vavular o ischemic heart disease, aortic atheromatosis and previous thromboembolic event [2,3,4,7]. Although our patient is a known case atrial fibrillation which is a well known risk factor for acute RAE, she was diagnosed as a case renal colic.…”

“…Renal artery embolism (RAE) is an event that is rarely reported in the literature and is easily misdiagnosed due to its nonspecific presentations [1] RAE typically associated with atrial fibrillation (AF) [2,3] , however other coexisting conditions have been associated with RAE including aneurysmal disease, valvular or ischemic heart disease and advanced malignancy, previous infarction and pulmonary embolism [2,4].…”

Isquemia renal aguda - causa rara de lumbalgia

“…En todas las series presentadas en la literatura se ha encontrado un predominio de eventos localizado a la izquierda [2][3][4] , debido según se cree al hecho de que el ángulo de implantación de la arteria renal izquierda es más favorable que el derecho. Los dos casos aquí presentados ocurrieron igualmente a la izquierda.…”

“…La fuente embólica potencial, aunque diversificada, tiene en la mayoría de los casos un origen cardiaco (Tabla 1) particularmente la fibrilación auricular secundaria a valvulopatías (presente en más de 50% de las series disponibles) [3][4][5][6] , seguida del infarto de miocardio. Causas más raras son la existencia de enfermedad arterial en forma de aneurisma de aorta o de la arteria renal.…”

“…El TAC se considera actualmente como el método diagnóstico no invasivo de referencia 4,13 . El aspecto clásico ("cortical rim sign") designa un área subcapsular con atenuación alta envolviendo un área de atenuación baja (ausencia de captación de contraste) en la fase nefrográfi-ca 14,15 .…”