ED presentations of acute renal infarction

Huang, Chun‐Yen; Lo, Hong Chang; Huang, Her Hsiung; Kao, Wei Fong; Yen, David Hung Tsang; Wang, Lee Min; Huang, Ching-Kuei; Lee, Chen Hsen

doi:10.1016/j.ajem.2006.06.010

Cited by 121 publications

(148 citation statements)

References 15 publications

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“…Consequently, she was followed conservatively and in her control abdominal CT scan, no further pathology was detected. Patients who have delayed diagnosis or are misdiagnosed will be subject to persistent symptoms and renal impairment (1). It is reported that serum creatinine is a good marker for predicting disease severity and the length of stay in hospital in renal infarction cases (3).…”

Section: Discussionmentioning

confidence: 99%

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Renal Infarction with two Different Etiologies: Two Case Reports

Gül¹,

Dündar²,

Ayan³

et al. 2012

JAEMCR

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Renal infarction is a rare clinical problem and it is frequently misdiagnosed because of the nonspecificity of its symptoms. We present two cases of renal infarction with two different etiologies. The first case was a 43-year-old male who attended the emergency department for pain in the left flank. A contrast-enhanced abdominal computed tomography scan was performed due to the persistent pain, and the segmental renal infarction was detected. The second case, a 6-year-old girl, was hospitalized due to falling from a height of 8 meters. Traumatic renal infarction was detected in the abdominal computed tomography scan which was performed during the assessment for multiple traumas. Both patients were followed-up conservatively and discharged from the hospital without any renal complications. The diagnosis of renal infarction is generally based on the clinical suspicion. Emergency physicians should keep renal infarction in mind during the management of the patients with abdominal, back or flank pain. Keywords

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Section: Discussionmentioning

confidence: 99%

“…It is often either misdiagnosed or treated initially as another condition such as urolithiasis or lumbago (1,2). Atherosclerosis, polycythemia vera, lupus erythematosus, trauma and cardiac factors such as atrial fibrillation, myocardial infarction, mitral stenosis are its primary causes (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Renal Infarction with two Different Etiologies: Two Case Reports

Gül¹,

Dündar²,

Ayan³

et al. 2012

JAEMCR

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“…In one case series, of seven patients who received thrombolysis, one developed end-stage renal disease, one had mild renal failure and two died [6]. In another case series, out of five patients, one patient's renal function did not recover or worsen during more than 1 year of follow-up [8]. In a case series reported by Korzets Z et al [14], one patient had a combination of intravenous heparin and renal intra-arterial urokinase infusion, but no improvement was observed.…”

Section: Discussionmentioning

confidence: 99%

“…Sonography is less important in diagnosis but can be helpful in corroborating the CT findings. In case of high probability of renal infarction, Haung CC et al [8] suggested to obtain a CECT of the abdomen if no calculi are detected after unenhanced CT. They were able to make the correct diagnosis in 50% of cases during their first visit to the ED.…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Infarction: An Underdiagnosed Disorder

Baig

2012

J Med Cases

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Acute renal infarction is usually diagnosed when the triad of flank pain, hematuria and elevated lactate dehydrogenase is observed. Since the symptoms are non specific, diagnosis requires high degree of suspicion or may be missed or confused with renal colic. The incidence of ARI in emergency department visits is 0.007 % whereas in autopsy series is reported 1.4 % indicating the condition goes undiagnosed frequently. With the increase use of contrast enhanced computed tomography and magnetic resonance angiography the accuracy might be improving at the present time.

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“…In fact, delayed diagnosis of this disease entity had been reported in 48-50% of the cases. 1,5 As such, treatment of this condition is largely aimed at prevention of embolization with anticoagulation because of the too-often late diagnosis.…”

Section: Discussionmentioning

confidence: 99%

A lady with unresolved loin pain

et al. 2008

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SummaryA history of cardiac disease, especially atrial fibrillation, together with symptoms such as loin or abdominal pain, and accompanied by an elevated lactate dehydrogenase should prompt a computed tomography scan to exclude the diagnosis of acute renal infarction. Case historyA 38-year-old lady was admitted to hospital with a two-day history of right loin pain and lethargy. The pain was colicky in nature and mostly experienced over the right lower abdominal quadrant and flank area. Physical examination showed a tired-looking patient with right costovertebral angle tenderness. Urinalysis showed microscopic haematuria 3+ and absence of pyuria. She had a white blood cell count of 13.9 × 10 9 /L with 89% polymorphs and a blood creatinine level of 1.0 mg/dL (91 µmol/L). The alanine transaminase level was 168 U/L, and the lactate dehydrogenase level was 1083 U/L (normal value 87-213 U/L). Both abdominal plain film and ultrasound showed no evidence of hydronephrosis or renal calculi. The following day she developed fever without chills. She was treated empirically as pyelonephritis with ciprofloxacin, which did not alleviate her symptoms. She also complained of palpitation symptoms two days after hospitalization; the electrocardiogram showed atrial fibrillation and no evidence of pulmonary embolism. A contrast-enhanced computed tomography of the abdomen and pelvis (Figure 1) was performed five days after admission because of unresolved fever and symptoms. It demonstrated multiple wedge shaped hypodensities indicative of multifocal infarcts involving the right kidney, with evidence of filling defect (thrombus formation) in the main renal artery causing partial obstruction. The patient was anticoagulated and underwent transthoracic and transesophageal echocardiogram. Grossly enlarged atria secondary to rheumatic mitral stenosis was noted with an estimated mitral valve area of 0.76 cm 2 . Apart from an organized thrombus detected over her left atrial appendage, no vegetations were seen on any heart valves.

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ED presentations of acute renal infarction

Cited by 121 publications

References 15 publications

Renal Infarction with two Different Etiologies: Two Case Reports

Renal Infarction with two Different Etiologies: Two Case Reports

Acute Renal Infarction: An Underdiagnosed Disorder

A lady with unresolved loin pain

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