Successful treatment of acute renal infarction arising from left atrial myxoma and atrial fibrillation: A case report

Abstract

Abstract. Acute renal infarction (ARI) is an uncommon disease and delayed diagnosis or misdiagnosis often leads to rapid deterioration of the patient. As patients with atrial fibrillation and left atrial myxomas are at risk of developing ARI due to cardiogenic thromboembolism, it is pivotal for clinicians to make a correct diagnosis and start a timely treatment. The present study reported on the case of a 68-year-old man who suffered from ARI secondary to thromboembolism associated with atrial fibrillation and left atrial myxomas. His renal function deteriorated rapidly after the onset of the attack. He was treated with anti-coagulant agents with excellent results. Classical anti-coagulation therapy remains to be the effective and safe treatment of ARI. IntroductionAcute renal infarction (ARI) is a severe condition requiring immediate treatment and is uncommon in clinical practice. It is often induced by the thrombogenesis or embolism to the renal artery trunk and branches, which leads to ischemic necrosis of renal tissues, kidney dysfunction and at times even irreversible renal parenchyma injury, leading to nephrectomy and even death in severe cases. As ARI does not have any typical clinical symptoms, it is easily misdiagnosed.The majority of ARI cases included a case series have been reported to be of cardiac origin (1). A retrospective study on 438 ARI patients reported that cardiac factors were accountable for ARI in 55.7% of the cases (2), while atrial fibrillation and left atrial myxoma were common cardiac factors inducing systemic thromboembolism (3,4). Other risk factors include myocardial ischemia, coagulation disorders, hypertension, obesity, peripheral vascular disease, smoking, a prior thromboembolic event and diabetes (2,5). Anti-coagulant and anti-thrombotic agents are classical therapeutics for ARI. A previous study reported that percutaneous renal artery fibrinolytic therapy with re-vascularization, including aspiration and rheolytic thrombectomy, achieved an excellent result (6). However, operation trauma, post-operative complications and high mortality have limited the application of open surgery. Regarding the prognosis of renal infarction, a retrospective study of 67 patients with renal infarction reported that 41% patients suffered from acute kidney disease (AKD) (7). Another study with 20 months of follow up showed that 20% of ARI patients developed AKD, 11% developed new-onset renal insufficiency and 2.1% progressed to end-stage renal disease (2). Therefore, early diagnosis and timely treatment of ARI are pivotal for maintaining renal function and to improve the prognosis of patients affected. The present study reported on a patient with coronary artery disease (CAD), atrial fibrillation and left atrial myxoma, who developed ARI. His right kidney had lost its function due to atrophy and his renal function rapidly deteriorated to an uremic level over a period of 3 days.The anti-coagulant agents low-molecular heparin and warfarin were used after timely diagnosis. His renal function eventuall...