Edit concept Question Editor Create issue ticket

Renal Infarction

Kidney Infarction

Renal infarction is a serious condition due to renal artery occlusion that needs rapid diagnosis, as it may lead to irreversible kidney damage. The diagnosis may be difficult to make, as patients present with nonspecific symptoms.


Presentation

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.

Fever
  • Abstract Patients with fever, flank pain, and dysuria frequently are encountered in the emergency department.[ncbi.nlm.nih.gov]
  • Abstract A 34-year-old man was admitted for acute onset of left lower abdominal pain associated with fever. His medical history was unremarkable, and the physical examination revealed bilateral flank tenderness.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA. charoen.mankongpaisarnrung@ttuhsc.edu Abstract A 52-year-old unvaccinated and splenectomized man presented with fever, altered[ncbi.nlm.nih.gov]
  • We noted abdominal or flank pain in 66 %, fever ( 37.6 C) in 36 %, and nausea/vomiting in 6 % of patients. The white blood cell count, and levels of lactate dehydrogenase and C-reactive protein peaked at 2-4 days after onset.[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]
Abdominal Pain
  • BACKGROUND: 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]
  • Abdominal computed tomographic (CT) scan on POD 9 for persistent abdominal pain revealed right renal infarction and right renal artery occlusion.[ncbi.nlm.nih.gov]
  • CONCLUSION: Concomitant presence of flank/abdominal pain, an increased risk for thromboembolism and an elevated LDH suggested a possibility of renal infarction.[ncbi.nlm.nih.gov]
  • Abstract A 34-year-old man was admitted for acute onset of left lower abdominal pain associated with fever. His medical history was unremarkable, and the physical examination revealed bilateral flank tenderness.[ncbi.nlm.nih.gov]
  • We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.[ncbi.nlm.nih.gov]
Vomiting
  • 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]
  • 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]
  • We noted abdominal or flank pain in 66 %, fever ( 37.6 C) in 36 %, and nausea/vomiting in 6 % of patients. The white blood cell count, and levels of lactate dehydrogenase and C-reactive protein peaked at 2-4 days after onset.[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]
  • 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]
Nausea
  • 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]
  • CASE OUTLINE: 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]
  • 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]
  • We noted abdominal or flank pain in 66 %, fever ( 37.6 C) in 36 %, and nausea/vomiting in 6 % of patients. The white blood cell count, and levels of lactate dehydrogenase and C-reactive protein peaked at 2-4 days after onset.[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]
Right Flank Pain
  • METHODS/ RESULTS: A 48-year-old man presented with right flank pain that was unresponsive to analgesia for renal colic. CT scan was performed revealing a partial renal infarction. The etiologic study was only positive to factor V Leiden.[ncbi.nlm.nih.gov]
  • flank pain who had history of a tendency toward thrombosis revealed extensive renal parenchymal changes secondary to renal infarction and a small size defect in the right kidney in addition to the patient's prior computed tomography results.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 46-year-old healthy man presented to our emergency room because of sudden onset of severe right flank pain.[ncbi.nlm.nih.gov]
  • A 42-year-old woman is reported who presented with persistent right flank pain after an alleged assault with injury to the area 3 weeks previously. Renal infarction necessitated a right nephrectomy that was followed by multiorgan failure and death.[ncbi.nlm.nih.gov]
  • flank pain radiating to the right lower quadrant of the abdomen.[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]
  • CASE PRESENTATION: We report the case of a 28-year-old Dalit Nepalese man who presented with sudden onset occipital headache and later developed severe left flank pain.[ncbi.nlm.nih.gov]
  • Abstract A 36-year-old diabetic man came to our institution presenting with constant left flank pain. Left renal embolic infarction was found by abdominal computed tomography.[ncbi.nlm.nih.gov]
  • We reported a 30-year-old healthy man presenting with sudden onset of left flank pain. Abdominal plain film and sonography were unremarkable.[ncbi.nlm.nih.gov]
  • Abstract A 44-year-old Italian man presented to the emergency department on three occasions over 4 days with severe left flank pain. Initial investigations including a renal tract ultrasound were normal and he was discharged with analgaesia.[ncbi.nlm.nih.gov]
Hypertension
  • […] of all causes of pediatric hypertension.[ncbi.nlm.nih.gov]
  • Conservative treatment was initially planned in consideration of the delayed diagnosis ( 3 hours), but the patient subsequently developed hypertension not controllable with anti-hypertensive drugs.[ncbi.nlm.nih.gov]
  • KEYWORDS: fibromuscular dysplasia; hypertension; renal artery; vascular medicine[ncbi.nlm.nih.gov]
  • SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients.[ncbi.nlm.nih.gov]
  • Muhannad Leghrouz Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, United States .[clinicsandpractice.org]
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]
  • 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]
  • Renal infarct causes severe flank pain that radiates to lower back and is often mistaken for back pain . In this article, we will study in detail about the causes, symptoms, and treatment options available for treatment of Renal Infarction.[epainassist.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]
Meningism
  • Subsequently, he was found to have pneumococcal infective endocarditis, pneumococcal pneumonia and bacterial meningitis, namely Austrian syndrome. He underwent an early aortic valve and mitral valve repair but still had a poor clinical outcome.[ncbi.nlm.nih.gov]
Flank Pain
  • Abstract 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]
  • CONCLUSION: A high index of suspicion of acute renal infarction is required in patients with risk factors of thrombosis presenting sudden onset flank pain.[ncbi.nlm.nih.gov]
  • Abstract A 36-year-old diabetic man came to our institution presenting with constant left flank pain. Left renal embolic infarction was found by abdominal computed tomography.[ncbi.nlm.nih.gov]
  • 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]
  • A 50-year-old active duty white male nonsmoker without medical history presented with flank pain. Urinalysis, complete blood count, LDH, and serum creatinine were normal.[ncbi.nlm.nih.gov]
Hematuria
  • 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]
  • 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]
  • Laboratory studies on presentation showed an elevated serum creatinine concentration and microscopic hematuria.[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]
  • 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]
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]

Workup

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.

Treatment

  • There was no difference in outcome for anticoagulation treatment with or without thrombolytics.[ncbi.nlm.nih.gov]
  • Conservative treatment was initially planned in consideration of the delayed diagnosis ( 3 hours), but the patient subsequently developed hypertension not controllable with anti-hypertensive drugs.[ncbi.nlm.nih.gov]
  • For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function.[ncbi.nlm.nih.gov]
  • Treatment is conservative, with parenteral and oral anticoagulation; invasive management is rare.[ncbi.nlm.nih.gov]
  • Definitive treatment of this vascular injury was obtained after percutaneous transcatheter embolization of the fourth right lumbar artery.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • This study analyzed the clinical and laboratory findings of patients diagnosed with renal infarction to determine whether it affects short- or long-term renal prognosis.[ncbi.nlm.nih.gov]
  • We describe the clinical features and renal prognosis of ARI in Japanese patients. METHODS: This single-center, retrospective, observational study included 33 patients with newly diagnosed ARI (2009-2013).[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]
  • Prognosis of renal infarction The approximate prognosis of either treated or untreated renal infarction is uncertain.[belmarrahealth.com]

Etiology

  • The most common etiology was atrial fibrillation. Computed tomography determined the specific cause for RI in 5 patients (13%) and a possible etiology in 17 (45%). Exact correlation with previous series was limited by methodological diversity.[ncbi.nlm.nih.gov]
  • The etiology was found to be renovascular in both patients, involving the occlusion of small renal arteries and causing SRI.[ncbi.nlm.nih.gov]
  • Fourteen patients (60.8%) with RI had atrial fibrillation (AF) as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis.[ncbi.nlm.nih.gov]
  • The etiologic study was only positive to factor V Leiden. In spite of the diagnosis and treatment it resulted in atrophy of the affected renal area.[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]

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiologic mechanisms include direct cocaine-induced platelet activation in combination with vasoconstriction and endothelial damage. There is no proven therapy for this complication.[ncbi.nlm.nih.gov]
  • 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 pathophysiologic effects of cocaine-induced renal injury involve several mechanisms. First, cocaine affects vascular reactivity and renal hemodynamics.[bmcnephrol.biomedcentral.com]
  • [Renal infarction: Pathogenesis, pathophysiology, and therapy]. Nihon Rinsho. 2006;64(Suppl 2):473–476. Japanese. 3. Scolari F, Ravani P. Atheroembolic renal disease. Lancet. 2010; 375(9726):1650–1660. 4. Turina S, Mazzola G, Venturelli C, et al.[dovepress.com]

Prevention

  • High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function.[ncbi.nlm.nih.gov]
  • High vigilance may prevent delay of the "golden hour" to treat acute myocardial infarction. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • Early recognition with prompt treatment may preserve organ function, avoid unnecessary management, and prevent debilitating complication.[ncbi.nlm.nih.gov]
  • We emphasize the importance of recognizing potential symptoms early to prevent additional renal injury. Caution should be taken with deformities around the origin of the renal arteries and great vessels, especially in patients with atherosclerosis.[ncbi.nlm.nih.gov]
  • […] eosinophiluria, and hypocomplementemia Nephrolithiasis stones seen on imaging lactate dehydrogenase is normal Treatment Medical anticoagulation indications atrial fibrillation hypercoagulable state delayed diagnosiss anticoagulation therapy is prophylactic to prevent[medbullets.com]

References

Article

  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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 08:32