Renal infarction

Revision as of 00:38, 27 January 2019 by ClaireLewis (talk | contribs) (Major causes)
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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

Clinical Features

Differential Diagnosis

Flank Pain

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
  • Endovascular therapy (thrombolysis/thrombectomy/angioplasty)
    • Indicated if acute occlusion involving main renal artery or segmental branches
    • Greatest likelihood of benefit if performed early
  • Anticoagulation:
    • IV Heparin followed by oral Coumadin
    • Indicated in patients with renal infarction in the setting of Atrial fibrillation, LV thrombus, and hyper coagulable state

Disposition

  • Admit

See Also

References

  1. 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.