Renal infarction usually occurs in patients with cardiovascular risk factors, such as arterial hypertension, atrial fibrillation, ischemic heart disease or valvulopathy, previous infarction or thromboembolism [1]. However, this condition can also be associated with malignancies, trauma, clotting disorders, kidney transplantation, fibromuscular dysplasia, Marfan and Ehlers-Danlos syndromes [2] or cocaine use [3].

Symptoms start abruptly and consist of abdominal, flank, costovertebral or lower back pain, nausea, vomiting, fever and sometimes oliguria [4] and hematuria [5]. Blood pressure may be high during the acute episode [6]. Small renal infarction may only cause fatigue [7].

On examination, the affected kidney may be palpable or tender. Symptoms due to shock such as hypotension, tachycardia and prolonged capillary refill time may be present.

If the disease occurs in pregnant women, symptoms include vaginal bleeding, lower abdominal pain and uterus contractions.

• Easy Bruising

  The phenotype is characterized by thin translucent skin with visible veins, spontaneous rupture of arteries, uterus or intestines, characteristic facial features, and easy bruising 1. [jrheum.org]

• Fever

  Patients with fever, flank pain, and dysuria frequently are encountered in the emergency department. [ncbi.nlm.nih.gov]

  […] an aseptic fever caused by liberation of pyrogens from damaged tissue. intestinal infarction a common occurrence in horses due to occlusion of arteries by larvae of Strongylus vulgaris. [medical-dictionary.thefreedictionary.com]

• Severe Pain

  A woman who was clinically diagnosed with dermatomyositis complained of severe pain in the right flank of the low back and abdomen, accompanied by nausea and vomiting during corticosteroid therapy. [ncbi.nlm.nih.gov]

  Flank pain: Experienced as very severe stabbing pain that is localized over the flank. Pain radiates to the lower back either on the left or right side. [belmarrahealth.com]

  Mild to moderate pain is treated with NSAIDs Opioids- Severe to very severe pain is treated with opioids. [epainassist.com]

  Although it can occur asymptomatically, the typical symptom is severe pain in the left upper quadrant of the abdomen, sometimes radiating to the left shoulder. [en.wikipedia.org]

• Dyspnea

  The underlying cause was not identified until an episode of acute dyspnea revealed paroxysmal arrhythmia. [ncbi.nlm.nih.gov]

  A few hours later the patient returned to the emergency department with severe right flank pain, dyspnea, and palpitations. [dovepress.com]

• Abdominal Pain

  Acute abdominal pain is one of the most frequent complaints evaluated at emergency departments. Approximately 25 % of abdominal pain patients discharged from emergency departments are diagnosed with undifferentiated abdominal pain. [ncbi.nlm.nih.gov]

• Vomiting

  The most common symptoms were abdominal pain, flank pain, nausea, and vomiting. Leukocytosis (>10 × 10(9)/L) and elevated lactate dehydrogenase levels (>620 IU/L) were the most prominent laboratory findings. [ncbi.nlm.nih.gov]

  Snapshot A 68-year-old man presents to the emergency room with a 2-day history of abdominal pain, nausea, and vomiting. He denies any urinary frequency or urgency and denies any recent changes in his diet. [medbullets.com]

  A 55-year-old woman was admitted as an emergency in renal failure following a history of several days of nausea and vomiting. [birpublications.org]

• Nausea

  A 62-year-old male patient was admitted with a sudden abdominal pain, right flank pain and nausea. He had a diastolic hypertension at admission and his previous medical history showed atrial fibrillation. [ncbi.nlm.nih.gov]

  Snapshot A 68-year-old man presents to the emergency room with a 2-day history of abdominal pain, nausea, and vomiting. He denies any urinary frequency or urgency and denies any recent changes in his diet. [medbullets.com]

• Right Flank Pain

  Here we present a case of a 41 year-old male who was admitted for acute onset right flank pain with fevers and rigors. A CT abdomen with contrast showed findings concerning for right pyelonephritis or renal infarction. [ncbi.nlm.nih.gov]

• Left Flank Pain

  We present an original case of a 41-year-old man, complaining of acute severe left flank pain, resistant to common analgesic therapy, who was diagnosed of segmental renal infarction of a branch of left renal artery. [ncbi.nlm.nih.gov]

• Hypertension

  Hypertension was diagnosed during the study of hematuria in the first case and due to a hypertensive emergency in the second case. [ncbi.nlm.nih.gov]

  Hypertension 2016; 68:832–839. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. [journals.lww.com]

• Back Pain

  He had complained of back pain 7 days after the ICD shock. Renal infarction was suspected, although computed tomography and magnetic resonance imaging could not be performed because of chronic renal failure and the presence of his ICD. [ncbi.nlm.nih.gov]

  Symptoms start abruptly and consist of abdominal, flank, costovertebral or lower back pain, nausea, vomiting, fever and sometimes oliguria and hematuria. Blood pressure may be high during the acute episode. [symptoma.com]

  Acute renal infarction as a cause of low-back pain. South Med J. 2003;96(5):497-9. 2. Dursun B, Yagci B, Batmazoglu M, Demiray G. Bilateral renal infarctions complicating fibromuscular dysplasia of renal arteries in a young male. [bjuinternational.com]

  Two nights prior to admission to our hospital, the patient experienced pain in the left flank, and the day before coming in, he had left lower back pain. [jxym.amegroups.com]

  If patient is suffering from acute renal infarction posse’s low back pain, flank and many more problems, in this stage, clinical treatment is not sufficient but it includes many treatments. [renaltreatment.com]

• Low Back Pain

  Acute renal infarction as a cause of low-back pain. South Med J. 2003;96(5):497-9. 2. Dursun B, Yagci B, Batmazoglu M, Demiray G. Bilateral renal infarctions complicating fibromuscular dysplasia of renal arteries in a young male. [bjuinternational.com]

  If patient is suffering from acute renal infarction posse’s low back pain, flank and many more problems, in this stage, clinical treatment is not sufficient but it includes many treatments. [renaltreatment.com]

• Flank Pain

  Acute renal infarction is a well known, although relatively unfrequent, cause of flank pain resistant to administration of spasmolytic and nonsteroidal anti-inflammatory drugs. [ncbi.nlm.nih.gov]

• Hematuria

  […] cell carcinoma", keywords = "Carcinoma, transitional cell, Hematuria, Infarction etiology, Kidney/blood supply, Urologic neoplasms", author = "Castle, {Erik P} and T. [mayoclinic.pure.elsevier.com]

  Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. [ncbi.nlm.nih.gov]

  Symptoms start abruptly and consist of abdominal, flank, costovertebral or lower back pain, nausea, vomiting, fever and sometimes oliguria and hematuria. Blood pressure may be high during the acute episode. [symptoma.com]

  Evaluation Labs Urinalysis is recommended, with hematuria being a very common finding, seen in all cases in one study. [3] However, hematuria is not universal, with about one-half of the patients in another study showing no hematuria, [22] and two cases [onlinejets.org]

  Indeed, there was almost a significant difference in the patients with hematuria who had normal renal function (10 of 21) compared to the patients without hematuria who had normal renal function (5 of 18, p = 0.059), indicating that the absence of hematuria [journals.lww.com]

• Oliguria

  After operation, oliguria and renal dysfunction developed, and he was admitted to our hospital because of acute renal failure after trauma. [ncbi.nlm.nih.gov]

  Symptoms start abruptly and consist of abdominal, flank, costovertebral or lower back pain, nausea, vomiting, fever and sometimes oliguria and hematuria. Blood pressure may be high during the acute episode. [symptoma.com]

  Of the clinical symptoms, pain was present in 81 of 89 (91%) cases, vomiting in 40%, fever in 49%, and oliguria in 16%. [journals.lww.com]

• Anuria

  Hemorrhagic renal infarction due to renal vein thrombosis Signs and Symptoms Flank pain or abdominal pain Hematuria Arterial hypertension Irregular heart rate Nausea, vomiting Oligouria, Anuria Diagnostic Work-Up Urine: Signs for kidney infarction are [urology-textbook.com]

  Renal artery embolism successfully revascularized by surgery after 5 days’ anuria. Is it never too late? Nephrol Dial Transplant 1996; 11:1843–1845. 13. Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, et al. [journals.lww.com]

• Renal Pain

  In early January 2015, he urgently presented at the hospital with left renal pain, caused by a renal infarction, diagnosed by computed tomography (CT) angiography. Left nephrectomy was performed with pathological confirmation. [ncbi.nlm.nih.gov]

Blood workup in suspected renal infarction patients should include a complete blood cell count that may show leukocytosis [8], elevated levels of lactate dehydrogenase, [9], creatinine, blood urea nitrogen, as well as, C-reactive protein and aminotransferases [2]. Fibrinogen level will be low and fibrin-degradation product levels will be high. Metabolic acidosis, hyperkalemia, and hypocalcemia may be encountered. Other causes of lactate dehydrogenase elevation, such as myocardial infarction, hemolysis or malignancy should be excluded. Urinary analysis will show macroscopic or microscopic hematuria [6] and proteinuria [2].

An electrocardiogram is useful in order to determine if atrial fibrillation, a risk factor for renal infarction, is present. Other imaging studies include spiral computer tomography, renal ultrasound, computer tomography or classical angiography and dimercaptosuccinic acid or diethylenetriamine penta-acetic acid radioisotope scan. Computer tomography is used to exclude nephrolithiasis [5] and other lesions. It shows a typical wedge-shaped parenchymal opacification defect, while angiograms are capable of highlighting the occluded vessel [10]. Seldom, the renal vein may also be occluded. If contrast agents are used, the physician should consider their toxicity on an already compromised kidney and even order hemodialysis, if needed.

The infarction usually involves both the cortical and medullary areas and extends into the renal capsule. Hematoma, if present, indicates kidney trauma or transection. If contrast enhanced computer tomography is performed eight to seventy-two hours after the infarction developed, the cortical rim sign appears: a thin rim of cortex is visualized, due to collateral perfusion. Ultrasound and contrast-enhanced ultrasound, although less precise, may show the absence of flow on color Doppler evaluation [11]. These methods are also capable of detecting preexisting infarctions, that appear as hyperechoic scar tissue. Scintigraphic imaging will show diminished or absent renal perfusion and function.

As a last resort, a kidney biopsy may be performed in order to establish the diagnosis and exclude malignancy, if the patient has no contraindications.

• Leukocytosis

  The majority of reported cases have presented with laboratory abnormalities, most notably leukocytosis and elevated lactate dehydrogenase (LDH). A 50-year-old active duty white male nonsmoker without medical history presented with flank pain. [ncbi.nlm.nih.gov]

  […] and thrombosis Emboli can affect vessels of various sizes depending on the size of the emboli Renal artery emboli usually come from cardiac source Embolic disease usually produces acute symptoms Sudden onset of flank pain Hematuria Proteinuria Fever Leukocytosis [learningradiology.com]

Treatment is conservative, with parenteral and oral anticoagulation; invasive management is rare. [ncbi.nlm.nih.gov]

This type of renal medical treatment is suitable when this disease has damaged the large part of kidney and it is not easy to recover by the above treatment. [renaltreatment.com]

It is associated with poor prognosis in a high percentage of cases. OBJECTIVES: To describe the main clinical, biochemical and radiologic features and to determine which factors are associated with poor prognosis (death or permanent renal injury). [ncbi.nlm.nih.gov]

الصفحة 53 - Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J. thorac. cardiovasc. Surg. ‏ الصفحة 84 - Rich MW, Crecelius CA. [books.google.com]

It is associated with poor prognosis in a high percentage of cases. Objectives To describe the main clinical, biochemical and radiologic features and to determine which factors are associated with poor prognosis (death or permanent renal injury). [revistanefrologia.com]

Work-up for common etiologies was negative and the renal infarction was presumed to be idiopathic. He was discharged home on Enoxaparin. [ncbi.nlm.nih.gov]

[…] cell carcinoma", keywords = "Carcinoma, transitional cell, Hematuria, Infarction etiology, Kidney/blood supply, Urologic neoplasms", author = "Castle, {Erik P} and T. [mayoclinic.pure.elsevier.com]

The authors review relevant pathophysiological background and epidemiology, recommend necessary diagnostic testing, and provide detailed medical, surgical, and endourological management approaches. [books.google.com]

The first section of the book presents epidemiological and clinical data in acute abdomen. The second and third sections document the key CT findings and their significance and discuss the technological background. [books.google.ro]

Introduction Clinical definition complete occlusion of main renal artery or segmental branch Epidemiology incidence very rare 0.7-1.4% found on autopsies risk factors cardiovascular disease Etiology cardioemboli cardiomyopathy endocarditis artificial [medbullets.com]

Inserm researchers Marcel Goldberg, Archana Singh Manoux and Marie Zins, from Inserm unit 1018 “Research Centre for Epidemiology and Public Health” and Université Versailles Saint Quentin, have contributed to the most extensive analysis ever carried out [presse.inserm.fr]

The epidemiology of varicella in staff and students of a hospital in torpics Int J Epidemiol 1984;13:502-5. [Figure 1] [indianjnephrol.org]

Pathophysiology of renal damage in cocaine users is multifactorial, and it has been postulated that the right kidney was more prone to ischaemia. Left kidney represents an extremely unusual site of cocaine-related renal infarction. [ncbi.nlm.nih.gov]

The authors review relevant pathophysiological background and epidemiology, recommend necessary diagnostic testing, and provide detailed medical, surgical, and endourological management approaches. [books.google.com]

The pathophysiologic effects of cocaine-induced renal injury involve several mechanisms. First, cocaine affects vascular reactivity and renal hemodynamics. [bmcnephrol.biomedcentral.com]

High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. [ncbi.nlm.nih.gov]

Stress prevention could reduce this risk. [presse.inserm.fr]

1. Argiris A. Splenic and renal infarctions complicating atrial fibrillation. Mt Sinai J Med. 1997;64:342-349.
2. Domanovits H, Paulis M, Nikfardjam M, et al. Acute renal infarction: Clinical characteristics of 17 patients. Medicine. 1999;78:386-394.
3. Kramer R, Turner R. Renal infarction associated with cocaine use and latent protein C deficiency. South Med J. 1993; 86:1436-1438.
4. Paris B, Bobrie G, Rossignol P,et al. Blood pressure and renal outcomes in patients with kidney infarction and hypertension. J Hypertens. 2006;24(8):1649–1654.
5. Chu P, Wei Y, Huang J, et al. Clinical characteristics of patients with segmental renal infarction. Nephrology. 2006;11(4):336–340.
6. Krishnan P, Anandh U, Fernandes DK, et al. Renal failure in a patient with primary antiphospholipid syndrome. J Assoc Physicians India. 2002;50:964–966.
7. Iga K, Izumi C, Nakano A, et al. Problems in the initial diagnosis of renal infarction. Intern Med. 1997; 36: 330-332.
8. Korzetz Z, Plotkin E, Bernheim J,et al. The clinical spectrum of acute renal infarction. Isr Med Assoc J. 2002;4(10):781–784.
9. Hazanov N, Somin M, Attali M, et al. Acute renal embolism. Forty four cases of renal infarction in patients with atrial fibrillation. Medicine. 2004;83(5):292–299.
10. Kawashima A, Sandler C, Ernst R etal. CT evaluation of renovascular disease. Radiographics. 2000;20(5): 1321-1340.
11. Malhi H, Grant EG, Duddalwar V. Contrast-Enhanced Ultrasound of the Liver and Kidney. Radiol. Clin. North Am. 2014;52(6):1177-1190.