Renal infarction
Background
- Low ED incidence, approximately 1 per 90 to 100, 000 visits a year
- Diagnosis frequently missed due to mimicking symptoms similar to other more frequent complaints such as pyelonephritis and nephrolithiasis
- Caused by interruption of blood supply to kidney
Major causes
- Cardioembolic disease
- Renal artery injury
- Hypercoagulable state
- Dissection
- Vasculitis
Clinical Features
- Flank pain
- Nausea, vomiting
- Sudden onset
Differential Diagnosis
Flank Pain
- Vascular
- Abdominal aortic aneurysm
- Renal artery embolism
- Renal vein thrombosis
- Aortic dissection
- Mesenteric ischemia
- Renal
- Pyelonephritis
- Papillary necrosis
- Renal cell carcinoma
- Obstructive uropathy
- May or may not be due to nephrolithiasis
- Renal infarction
- Renal hemorrhage
- Ureter
- Nephrolithiasis
- Blood clot
- Stricture
- Tumor (primary or metastatic)
- Bladder
- Tumor
- Varicose vein
- Cystitis
- GI
- Biliary colic
- Pancreatitis
- Perforated peptic ulcer
- Appendicitis (appendix may be pushed to RUQ in pregnancy)
- Inguinal Hernia
- Diverticulitis
- Cancer
- Bowel obstruction
- Gynecologic
- GU
- Other
- Shingles
- Lower lobe pneumonia
- Retroperitoneal hematoma/abscess/tumor
- Epidural abscess
- Epidural hematoma
- Rib contusion/fracture
Evaluation
Laboratory
- CBC with differential, CMP, LDH, urinalysis, urine culture
- EKG- to evaluate for arrhythmia
Imaging[1]
- CT with IV contrast (preferred study)
- Renal ultrasound - less senstive
- MRI with gadolinium (contraindicated with severe renal impairment due to risk of nephrogenic systemic fibrosis)
- Radioisotope scan - not commonly used
Management
- No clinical guidelines available, but mainstays of therapies include anticoagulation and endovascular therapy
- Acute occlusion involving main renal artery or segmental branches:
- Endovascular therapy (thrombolysis/thrombectomy/angioplasty)
- Greatest likelihood of benefit if performed early
- Endovascular therapy (thrombolysis/thrombectomy/angioplasty)
- Anticoagulation:
Disposition
- Admit
See Also
References
- ↑ Decoste R, Himmelman JG, Grantmyre J. Acute renal infarct without apparent cause: A case report and review of the literature. Canadian Urological Association Journal. 2015;9(3-4):E237-E239. doi:10.5489/cuaj.2466.
- ↑ Antopolsky M, Simanovsky N, Stalnikowicz R, et al. Renal infarction in the ED: 10-year experience and review of the literature. Am J Emerg Med 2012; 30:1055.