Renal infarction

Abstract

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...

Acute Renal Infarction Presenting with Acute Abdominal Pain Secondary to Newly Discovered Atrial Fibrillation: A Case Report and Literature Review

“…Laboratory findings usually include elevated serum lactate dehydrogenase (LDH), C-reactive protein, leukocytosis, microscopic hematuria, proteinuria, elevated serum creatinine, and creatinine kinase. Oliguria can happen [ 13 , 15 ]. Our case was remarkable only for elevated serum LDH and leukocytosis.…”

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Acute Renal Infarction Pathogenesis and Atrial Fibrillation: Case Report and Literature Review

“…Amongst these antiphospholipid syndrome (APS), antithrombin III deficiency, factor V Leiden, protein C and S deficiencies, hyperhomocysteinemia and polycythemia vera play an important role [17,18]. APS can cause both arterial and venous thrombotic events and while these events mostly involve lower limb deep veins and cerebral arteries, the renal circulation can also be targeted.…”

Acute renal infarction and cardioembolic stroke in a patient with atrial fibrillation and hyperthyroid-induced cardiomyopathy: a case report

“…Acute renal infarction (ARI) is a rare entity often presenting with misleading manifestations, which may result in its diagnostic delay, misdiagnosis and treatment leading to renal loss [ 1 , 2 ]. Flank pain, fever, and nausea/vomiting are the commonest presentations of ARI [ 3 ].…”