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Gibson SD, Lourenço BN, De la Rosa MB, Coleman AE, McLaughlin C, Arne A, Harris TL, Ziccardi C, Vaden SL. Diagnostic Value of Echocardiography in Cats With and Without Ultrasonographic Evidence of Renal Infarction. J Vet Intern Med 2025; 39:e70107. [PMID: 40275464 DOI: 10.1111/jvim.70107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/09/2025] [Accepted: 04/11/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND Revisiting the association between heart disease and renal infarction (RI) in cats is relevant to determine whether those with RI should undergo echocardiographic screening. OBJECTIVE Compare the relative frequency of echocardiographically detectable heart disease and other comorbidities in cats with and without ultrasonographic evidence of RI. ANIMALS A total of 826 cats that underwent concurrent abdominal ultrasonography and transthoracic echocardiography and were assigned a cardiac diagnosis. METHODS Two-center cross-sectional study with a study population recruitment period from January 1, 2011 to June 15, 2021. Demographic, clinical, clinicopathologic, and ultrasonographic data were recorded. Available echocardiographic images were reviewed to assign a standardized cardiac diagnosis. Occult heart disease was defined as structural heart disease without clinical signs of congestive heart failure. Risk factors for RI were evaluated by univariable or multivariable logistic regression. RESULTS The relative frequency of structural heart disease in cats with and without RI was 63% (114/181) and 46% (297/645), respectively (adjusted odds ratio [OR] 95% confidence interval [CI], 1.6; 1.2-2.3). Older age (p = 0.03), higher maximum end-diastolic left ventricular wall thickness (p = 0.02), higher systolic blood pressure (p = 0.02), auscultable cardiac abnormalities other than murmur (p = 0.04), and diagnosis of acute kidney injury (p = 0.002), chronic kidney disease (p = 0.005), and occult heart disease (OR [95% CI], 2.4 [1.7-3.4]; p ≤ 0.001) were associated with increased risk of RI. Strength and statistical significance of associations varied by site. CONCLUSIONS AND CLINICAL IMPORTANCE Occult heart disease is more frequent in cats with RI, and echocardiographic screening of these cats should be considered.
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Affiliation(s)
- Scott D Gibson
- Department of Small Animal Medicine & Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Bianca N Lourenço
- Department of Small Animal Medicine & Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Metzere Bierlein De la Rosa
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Amanda E Coleman
- Department of Small Animal Medicine & Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Chris McLaughlin
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Allison Arne
- Department of Small Animal Medicine & Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Tonya L Harris
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Christianna Ziccardi
- Department of Small Animal Medicine & Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Shelly L Vaden
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
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Rau Y, Matrisch L. Incidence and Epidemiology of Kidney Infarctions in Germany-A Cohort Study. EPIDEMIOLOGIA 2025; 6:19. [PMID: 40265350 PMCID: PMC12015852 DOI: 10.3390/epidemiologia6020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 02/18/2025] [Accepted: 04/07/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to quantify and analyze the incidence and epidemiology of kidney infarctions between 2012 and 2022 in Germany. METHODS We analyzed and extracted data from the national database of federal health reporting. Incidence rates were calculated and stratified by gender and age. Statistical analysis involved linear regression to assess correlations between incidence, age, and reporting year, with significance determined using F-tests and Student's t-tests. RESULTS From 2012 to 2022, 7983 cases of kidney infarction (4769 male, 3214 female) were identified. The mean incidence was 8.81 per million per year, higher in males (10.7) than females (6.99). Incidence peaked among individuals aged 50-59 years. A significant decrease in incidence over the study period was observed, particularly among males (-2.49 per million per year) compared to females (-0.87 per million per year). Linear regression showed a significant correlation between incidence and age (F(1,6) = 131, p < 0.001) and a significant overall incidence decrease over time (F(1,9) = 40.5, p < 0.001). CONCLUSIONS This study provides the first nationwide epidemiological data on kidney infarction in a Western country. The downward trend, especially among males, may be due to the improved management of risk factors like atherosclerosis and atrial fibrillation, e.g., through an increase in the prescription of direct anticoagulatory agents. Despite the decrease, kidney infarction remain a significant cause of acute kidney injury. Further research is needed to understand these trends and improve preventive strategies.
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Affiliation(s)
- Yannick Rau
- Department of Internal Medicine, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730 Neustadt, Germany
| | - Ludwig Matrisch
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Lin JW, Chen CT, Kuo Y, Jeng MJ, How CK, Huang HH. Risk factors for mortality among patients with splenic infarction in the emergency department. J Formos Med Assoc 2025; 124:375-380. [PMID: 38763857 DOI: 10.1016/j.jfma.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Splenic infarction is relatively uncommon with a mortality rate ranging from 5% to 34% reported in the literature. Research that focuses on this disease, particularly regarding its mortality risk factors, is scarce. This study aimed to identify the characteristics of splenic infarction and investigate risk factors for 30-day mortality in patients diagnosed with this disease in an emergency department (ED). METHODS This retrospective cohort study utilized a computed tomography (CT) database search to identify adult patients who received their first diagnosis of splenic infarction via CT scan during ED visits at a Taiwanese medical center from January 2011 to December 2021. The study employed logistic regression analysis to identify prognostic factors for 30-day mortality. RESULTS The study involved 73 patients with a median age of 71 years. ICU admission was required for 23.3% of patients, and the average hospital stay was 14 days. The 30-day mortality rate was 23.3%. Univariate logistic regression analysis revealed several mortality risk factors, including low hemoglobin level, diabetes mellitus, uremia requiring renal replacement therapy, active malignancy, high Taiwan Triage and Acuity Scale (TTAS) level, increased qSOFA score, along with high MEWS. Multivariate logistic regression analysis identified uremia requiring renal replacement therapy, active malignancy, and high TTAS level as independent predictors. CONCLUSION For ED patients with splenic infarction, the 30-day mortality rate was 23.3%. Independent predictors of mortality included uremia requiring renal replacement therapy, active malignancy, and high triage levels.
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Affiliation(s)
- Jin-Wei Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Ting Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Skeik N, Theeler J, Wang J, Bae A, Cho M, Manunga J. Renal Artery Vasculopathy: Case Study and Literature Review. Angiology 2025:33197251316625. [PMID: 39968596 DOI: 10.1177/00033197251316625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
Non-atherosclerotic renal artery vasculopathies are rare and can be caused by heterogenous group of diseases, some of which has bad prognosis. The literature addressing this rare group of disease is scarce. A single center analysis of all adult patients evaluated for renal artery disease including dissection, aneurysm, stenosis, vasculitis, thrombosis, irregularity, and renal infarct treated at our center, from January 2000 to April 2022. Baseline data collected included demographics, comorbidities, vital signs, laboratory values, pathology, genetic testing, and imaging results/diagnoses. Additionally, treatment modality, follow-up, and symptom relief/recurrence from follow-up visits were collected if available. Out of the included 227 patients, 91 (40%) had renal infarction, 70 (31%) had renal artery dissection, 69 (30%) had aneurysm, 33 (15%) had stenosis, and 32 (14%) had thrombosis. The most common diagnoses were fibromuscular dysplasia (n = 86, 38%) and thromboembolism (n = 38, 17%). Most patients improved with conservative management, reserving endovascular or surgical interventions for symptomatic patients with more complicated presentations. To our knowledge, this is the only case study and general review in the literature that addresses the diagnosis and management of non-atherosclerotic renal arteriopathies showing good outcome for most of the underlying etiologies.
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Affiliation(s)
- Nedaa Skeik
- Section of Vascular and Endovascular Surgery Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Johanna Theeler
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Julia Wang
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Aaron Bae
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Mansoo Cho
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Jesse Manunga
- Section of Vascular and Endovascular Surgery Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
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Santamarina MG, Necochea Raffo JA, Lavagnino Contreras G, Recasens Thomas J, Volpacchio M. Predominantly multiple focal non-cystic renal lesions: an imaging approach. Abdom Radiol (NY) 2025; 50:224-260. [PMID: 38913137 DOI: 10.1007/s00261-024-04440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024]
Abstract
Multiple non-cystic renal lesions are occasionally discovered during imaging for various reasons and poses a diagnostic challenge to the practicing radiologist. These lesions may appear as a primary or dominant imaging finding or may be an additional abnormality in the setting of multiorgan involvement. Awareness of the imaging appearance of the various entities presenting as renal lesions integrated with associated extrarenal imaging findings along with clinical information is crucial for a proper diagnostic approach and patient work-up. This review summarizes the most relevant causes of infectious, inflammatory, vascular, and neoplastic disorders presenting as predominantly multiple focal non-cystic lesions.
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Affiliation(s)
- Mario G Santamarina
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile.
- Radiology Department, Hospital Dr. Eduardo Pereira, Valparaiso, Chile.
| | - Javier A Necochea Raffo
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile
| | | | - Jaime Recasens Thomas
- Departamento de Radiología, Escuela de Medicina, Universidad de Valparaíso, Valparaiso, Chile
| | - Mariano Volpacchio
- Radiology Department, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
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Miles L, Shin B, Ji H, Ghaffari-Rafi S, Chitsazan M, Kim DI. Multifocal Renal Infarction and Diabetic Ketoacidosis: Diagnostic Challenges and Anticoagulation Management in a Complex Case. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e945456. [PMID: 39460375 PMCID: PMC11526170 DOI: 10.12659/ajcr.945456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/11/2024] [Accepted: 08/28/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND Incidental findings of renal infarct secondary to thrombosis in acutely ill patients present a unique challenge in diagnosis. We present a case of idiopathic renal infarct to highlight its workup and management and encourage further investigation of renal infarctions. CASE REPORT A 68-year-old woman with a past medical history of diet-controlled diabetes, hypertension, and hyperlipidemia presented to the Emergency Department (ED) for abdominal pain. She was found to be in diabetic ketoacidosis with pyelonephritis, so she was admitted to the Intensive Care Unit (ICU) for insulin and dextrose drip. Due to her abdominal pain, she underwent computed tomography (CT) of her abdomen and pelvis with contrast. This revealed multifocal infarcts of her right kidney with noncalcified thrombus at the proximal right renal artery. Subsequent CT angiography confirmed a right renal artery thrombus. She was started on subcutaneous enoxaparin and downgraded to basic level of care. Her history was negative for prior thrombosis, hypercoagulable state, and abdominal trauma. Echocardiogram and limited hypercoagulable workup were largely unremarkable. A multidisciplinary team evaluated the patient and recommended no surgical intervention. Following downgrade from the ICU, the patient was transitioned from enoxaparin to apixaban. She was discharged with plans for anticoagulation for 6 months, aspirin daily, and repeat CT angiogram abdomen/pelvis in 1 month. CONCLUSIONS This case illustrates the difficulties in elucidating the cause of incidental renal thrombosis in an acutely ill patient. Diagnostic workup is limited in the inpatient setting, but therapeutic anticoagulation remains the standard of treatment regardless of etiology.
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Affiliation(s)
- Levi Miles
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Brandon Shin
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Hyein Ji
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Shadeh Ghaffari-Rafi
- Department of Internal Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Morteza Chitsazan
- Department of Internal Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Daniel I. Kim
- Department of Internal Medicine, Riverside University Health System, Moreno Valley, CA, USA
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Greenberg S, Jana K, Janga K, Lee MH, Lockwood M. Acute Renal Infarction: A 12-Year Retrospective Analysis. Nephron Clin Pract 2024; 149:11-17. [PMID: 39250895 DOI: 10.1159/000541333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/07/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION Acute renal infarction (ARI) is a relatively rare and underdiagnosed condition. Presenting symptoms are nonspecific, and imaging is the mainstay for diagnosis. This study attempts to characterize the profile of patients with ARI and identify possible risk factors. METHODS All inpatients admitted with diagnosis of ARI between 2010 and 2022 were included in this single-center retrospective observational study. Patients with chronic renal infarction, iatrogenic causes, and without radiographic evidence of ARI were excluded. Clinical, laboratory, and radiological findings of patients were collected. Patients were grouped into three groups based on probable etiology: cardiovascular, hypercoagulable disorders, and idiopathic, and analyzed. RESULTS Eighty-five patients were included. Mean age of patients was 61.6 ± 17.54 years. Cardiovascular group had the highest number of patients (49.4%) of which atrial fibrillation was the most common etiology (59.5%). Malignancy was the most common etiology in the hypercoagulable disorder group (69.3%). Patients in the idiopathic group were significantly younger and had higher mean body mass index than the other 2 groups at presentation. Smokers had 9 times higher risk of renal infarction in cardiovascular group and 1.7 times higher risk in hypercoagulable when compared to the idiopathic group. 48.2% of patients developed renal infarction though they were on antiplatelets/anticoagulants. CONCLUSION ARI is a rare and often underdiagnosed condition that can have residual renal dysfunction. It is important to consider ARI as a differential especially in young patients with risk factors even if they are on anticoagulation medication.
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Affiliation(s)
- Sheldon Greenberg
- Division of Nephrology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kundan Jana
- Division of Nephrology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kalyana Janga
- Division of Nephrology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Meng-Hsun Lee
- Division of Nephrology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Mary Lockwood
- Division of Nephrology, Maimonides Medical Center, Brooklyn, New York, USA
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Mudarres MF, Azrieh B. A Case of Renal Artery Thrombosis With Concurrent Adrenal Hemorrhage in Polycythemia Vera. Cureus 2024; 16:e68809. [PMID: 39371836 PMCID: PMC11456319 DOI: 10.7759/cureus.68809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2024] [Indexed: 10/08/2024] Open
Abstract
Polycythemia vera (PV) is a rare myeloproliferative neoplasm characterized by the clonal proliferation of hematopoietic stem cells, leading to an elevated red blood cell mass. This hyperproliferative state increases blood viscosity and predisposes patients to thrombotic events, which are a significant cause of morbidity and mortality in PV. The diagnosis of PV is typically confirmed through elevated hemoglobin or hematocrit levels, low serum erythropoietin, and the presence of the Janus kinase 2 (JAK2) mutation. Common complications include venous and arterial thromboses, hemorrhage, and transformation to myelofibrosis or acute leukemia. A 68-year-old female with a history of PV and chronic kidney disease (CKD) presented with uremic symptoms in the form of malaise and nausea. Laboratory investigations indicated acute kidney injury (AKI) and hyperkalemia. Imaging evaluation of renal US Doppler revealed renal artery thrombosis and an incidental adrenal hemorrhage. The patient was managed with intravenous heparin and did not receive thrombolytics or thrombectomy. Her renal function did not improve, necessitating the initiation of hemodialysis (HD) during hospitalization. Over the course of the next few weeks, her renal parameters improved and she managed to be discharged from dialysis. The primary goal of this study was to highlight a rare presentation of renal artery thrombosis secondary to polycythemia vera (PV) and discuss the complexities involved in managing the underlying disease and its thrombotic complication, particularly in the presence of concomitant bleeding. Effective management of PV-related thrombosis requires a delicate balance between anticoagulation to prevent further thrombotic events while carefully addressing the risk of hemorrhage.
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Affiliation(s)
| | - Bahjat Azrieh
- Nephrology, University of Iowa Hospitals and Clinics, Iowa, USA
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Mohamed Aden F, Djafarou Boubacar R, Ekhya Amoumoune F, Atteyeh sougal M, Diallo TH, Faraj R, Mouine N, Benyass A. Atrial fibrillation and flank pain: Think renal infarction: A case report. Radiol Case Rep 2024; 19:3946-3948. [PMID: 39050643 PMCID: PMC11266867 DOI: 10.1016/j.radcr.2024.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 07/27/2024] Open
Abstract
Renal infarction is a rare pathology, threatening the functional prognosis of the kidney. Given the lack of clinical features specific to this pathology, the practitioner may wrongly diagnose pyelonephritis or other causes of abdominal pain. Renal infarction frequently occurs in patients with thromboembolic risk factors, most often secondary to atrial fibrillation. We report the case of a 49-year-old patient, with no previous history, who presented to the emergency room with palpitations and pain in the right flank with an atrial fibrillation rhythm on the ECG, in whom abdominal CT angiography showed signs of a focal renal infarction of the right kidney. Later, the progression was towards non-traumatic macroscopic hematuria with preservation of normal renal function, which resolved spontaneously after a few days. AF was accepted in the face of significant dilatation of the left atrium, in consultation with the patient, and he was put on a beta-blocker to control the rate. Renal infarction must be considered despite its rarity to initiate adequate treatment and increase the chances of renal rescue.
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Affiliation(s)
| | | | | | | | | | - Raid Faraj
- Department of Cardiology B, Ibn Sina University Hospital, Rabat, Morocco
| | - Najat Mouine
- Cardiology Center, Mohammed V Military Training Hospital, Rabat, Morocco
| | - Aatif Benyass
- Cardiology Center, Mohammed V Military Training Hospital, Rabat, Morocco
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Choi IH, Kim CS, Bae EH, Ma SK, Kim SW, Choi HS. A Case of Recurrent Renal Infarction Following Transient Resolution: Evidence From Serial Computed Tomography. Electrolyte Blood Press 2024; 22:16-20. [PMID: 38957546 PMCID: PMC11214911 DOI: 10.5049/ebp.2024.22.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 07/04/2024] Open
Abstract
Although renal infarction (RI) is not a rare disease, its outcomes have not been well-documented. Furthermore, transient resolution and recurrence of RI have not been captured through imaging. We report a case of idiopathic RI that recurred within a short period following transient resolution, as demonstrated by serial computed tomography (CT). A 53-year-old man diagnosed with RI was transferred to the emergency room. An abdominal CT scan at the local hospital revealed a segmental wedge-shaped perfusion defect in the left kidney and a focal thrombotic filling defect in the anterior segmental branch of the left renal artery. Since his left flank pain improved, another CT scan was performed again 6 hours after the initial CT scan. A repeat CT scan showed that the thrombus in the renal artery remained, but the perfusion defect had spontaneously resolved. We initiated anticoagulant therapy using unfractionated heparin. On the sixth day of hospitalization, the left flank pain recurred, prompting another CT scan. The follow-up CT scan confirmed that RI had recurred in the same area as before. We continued anticoagulant therapy and switched to warfarin. After treatment, his symptoms improved, and he was discharged. RI can recur at any time, even after it has spontaneously resolved, as evidenced by our case. Therefore, it is crucial to closely monitor patients who experience resolution of RI for any recurrence of symptoms, and repeat radiological evaluation should be performed even within a short period.
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Affiliation(s)
- In Hong Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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11
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Baghi MA, Purayil NK, Naushad VA, Varikkodan I, Alarbi KMS, Habas E. Renal Infarction in SARS-CoV-2 Infection: A Case Report. Cureus 2024; 16:e62415. [PMID: 39011195 PMCID: PMC11247356 DOI: 10.7759/cureus.62415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 and associated with a wide spectrum of clinical manifestations ranging from asymptomatic carrier states to fulminant respiratory distress and multiple organ dysfunction. The intravascular arterial and venous thrombotic phenomena are one of the most prevalent and devastating consequences and tend to occur in patients with a severe disease state. Here we present a 45-year-old male with a medical history of essential hypertension (HTN) who presented with severe left flank pain accompanied by dry cough and fever for five days. He was found to have acute kidney injury (AKI) with concomitant renal infarction in computed tomography angiography (CTA) in the setting of a COVID-19 infection. He was eventually managed with novel oral anticoagulation (NOAC) and was discharged after a short hospital stay. Follow-up thereafter showed stable baseline renal function with no relevant symptoms.
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Affiliation(s)
- Mohamed A Baghi
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Internal Medicine, College of Medicine-Qatar University (QU) Health, Qatar University, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
| | - Nishan K Purayil
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Internal Medicine, College of Medicine-Qatar University (QU) Health, Qatar University, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
| | - Vamanjore A Naushad
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Internal Medicine, College of Medicine-Qatar University (QU) Health, Qatar University, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
| | - Irfan Varikkodan
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Internal Medicine, College of Medicine-Qatar University (QU) Health, Qatar University, Doha, QAT
| | | | - Elmukhtar Habas
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT
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Sega M, Yamashita M, Maruyama H, Taya Y, Ohgi K, Haraoka R, Hirayama K. Renal Embolism Associated with the Atrial Myxoma: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:694. [PMID: 38792877 PMCID: PMC11123329 DOI: 10.3390/medicina60050694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Renal embolisms due to cardiac myxomas are extremely rare; the clinical course, treatment, and prognosis of this disease are not established. A 69-year-old Japanese woman who underwent a nephrectomy for renal cell carcinoma 3 years earlier was hospitalized with a right occipital lobe cerebral infarction. Her renal function suddenly worsened 3 days post-admission: her serum creatinine rose from 1.46 mg/dL to 6.57 mg/dL and then to 8.03 mg/dL the next day, and hemodialysis therapy was started. Abdominal computed tomography (CT) scans showed patchy non-contrasted low-density areas in the right kidney, and chest CT scans and transesophageal ultrasonography revealed a left atrial tumor. We diagnosed renal infarction due to a left atrial myxoma. Hemodialysis and anticoagulant therapy (heparin) were continued, followed by the cardiac myxoma's resection. The patient's renal function gradually improved post-surgery, and the hemodialysis was discontinued. Considering our patient and 19 other case reports of renal infarction associated with cardiac myxoma, the treatment for such a renal infarction and the outcomes differ depending on the embolus site. The poor outcome of abdominal aortic embolism requires a prompt embolectomy, whereas a branch renal artery embolism requires anticoagulation therapy to prevent thrombosis formation around the myxoma.
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Affiliation(s)
- Masatoshi Sega
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Marina Yamashita
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Hiroshi Maruyama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Yuji Taya
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Kentaro Ohgi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
- Department of Intensive Care Medicine, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Rei Haraoka
- Department of Neurosurgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
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13
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Bowie RA, Clapp AD, Reese RL, Nguyen CQ, Chipi PY. A Case Report of Renal Infarcts Secondary to Segmental Arterial Mediolysis. Cureus 2024; 16:e58933. [PMID: 38659713 PMCID: PMC11042666 DOI: 10.7759/cureus.58933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 04/26/2024] Open
Abstract
Flank pain is an exceptionally common presenting symptom in the emergency and primary care setting; however, most clinicians may not include a differential diagnosis of renal infarct (RI) due to the reported low incidence of this condition. Delayed diagnosis or treatment intervention for RI can have dire consequences for the patient including hypertension and longstanding renal impairment. In this report, we review a case of a previously healthy 39-year-old male presenting with flank pain, which after extensive workup, was revealed to be caused by renal infarction from a renal artery dissection secondary to segmental arterial mediolysis (SAM).
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Affiliation(s)
| | | | - Robyn L Reese
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School Multicampus Geriatric Fellowship Program, Boston, USA
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14
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Gaffar S, Dhayalan D, Li H, Doraiswamy M, Baskaran N. Bilateral Renal Infarct in a Young Adult: Unveiling an Autoimmune Enigma. Cureus 2024; 16:e59095. [PMID: 38803708 PMCID: PMC11128336 DOI: 10.7759/cureus.59095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
A man in his late 20s presented to the emergency department with sudden-onset abdominal pain. Urinalysis was significant for hematuria and slightly elevated creatinine. A computed tomography (CT) scan with IV contrast revealed bilateral renal infarcts, which was corroborated by a computed tomography angiogram (CTA). Further evaluation by an autoimmune panel demonstrated a positive antinuclear antibody, while echocardiography showed left ventricular non-compaction cardiomyopathy. The workup included consultations with multiple specialities and additional investigations to assess hypercoagulability, vasculitis, and infectious etiologies. Following supportive care, the patient was discharged in stable condition with a plan for outpatient follow-up and further workup, including screening of first-degree family members for left ventricular non-compaction and associated cardiovascular risks. Here we describe a report of a rare case of bilateral renal infarct of possible thromboembolic etiology due to an underlying rare genetic cardiovascular condition.
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Affiliation(s)
- Sheima Gaffar
- Internal Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekharam, IND
| | | | - Han Li
- College of Medicine, University of Florida, Gainesville, USA
| | - Mohankumar Doraiswamy
- Internal Medicine, Mercy Hospital Northwest Arkansas, Rogers, USA
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
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15
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Damlakhy A, Harmouch KM, Khan ZA, Kumar N, Abdel-Qader A. Renal Infarction as the First Manifestation of Undiagnosed Atrial Fibrillation With Coexisting Left Atrial Thrombus: A Case Report and Review of the Literature. Cureus 2024; 16:e53772. [PMID: 38465080 PMCID: PMC10923261 DOI: 10.7759/cureus.53772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Acute renal infarction, presenting with nonspecific symptoms, such as abdominal pain, nausea, vomiting, and hematuria, can lead to delayed diagnosis due to similarities with other medical conditions. Computed tomography with IV contrast is used to diagnose renal parenchymal infarction, treated through surgical, percutaneous interventions, and anticoagulation therapy. Investigation for the infarction source is crucial, particularly in the absence of prior cardiac issues, necessitating heart rhythm monitoring and an echocardiogram to evaluate paroxysmal atrial fibrillation (PAF) and intracardiac thrombus, respectively. Renal infarction may elevate blood pressure due to renin release, recommending medications like angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. We present a case of renal infarction due to PAF with a concomitant intracardiac thrombus.
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Affiliation(s)
- Ahmad Damlakhy
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Khaled M Harmouch
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Zohaib A Khan
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Nomesh Kumar
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Anas Abdel-Qader
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
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16
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Sicard JJ, Liz VDJ, Gomez M, Castillo R. Segmental infarction of the kidney upper pole as cause of acute back pain. Urol Case Rep 2024; 52:102635. [PMID: 38188587 PMCID: PMC10767311 DOI: 10.1016/j.eucr.2023.102635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Renal infarction is a rare condition often misdiagnosed as more common renal disorders due to similar symptoms. This case report highlights a 52-year-old patient who presented with severe lumbago and was diagnosed with segmental renal infarction in the upper pole of the left kidney. The patient's clinical course, diagnostic evaluation, and multidisciplinary management are described. The importance of early diagnosis through imaging techniques, such as computed tomography, is emphasized. Treatment strategies, including anticoagulation and pain management, are discussed. This case underscores the need for a high index of suspicion to ensure timely diagnosis and appropriate management of renal infarction.
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Affiliation(s)
| | | | - Maria Gomez
- Servicio Nacional de Salud, Dominican Republic (SNS), Dominican Republic
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17
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Kozyrakis D, Kallinikas G, Zarkadas A, Bozios D, Konstantinopoulos V, Charonis G, Safioleas K, Filios A, Rodinos E, Mytiliniou D, Vlassopoulos G, Gkerzelis I, Filios P. Renal artery infarction in the SARS-Cov-2 era: A systematic review of case reports. Arch Ital Urol Androl 2023; 95:11625. [PMID: 37791549 DOI: 10.4081/aiua.2023.11625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
AIM Renal artery infarction (RI) is the presence of blood clot in the main renal artery or its branches causing complete or partial obstruction of the blood supply. Its etiology is either related with disorders of the renal vasculature or with cardiovascular diseases. Recently, the SARSCoV- 2 virus is an emerging cause of thromboembolic events and the incidence of RI is anticipated to increase after the pandemic. METHODS A systematic review based on COVID-19 associated RI was conducted. PROTOCOL A systematic review of the Medline/Pubmed and Scopus databases was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA statement). Search strategy and information sources: A hand-search was performed using the terms "SARS-Cov-2" OR "COVID-19" AND "renal thrombosis" OR "renal infarction" OR "renal "thromboembolism". ELIGIBILITY CRITERIA all types of publications (case reports, case series, letters to the editor, short communications) were evaluated for relevance. Inclusion criteria were: confirmed SARS-Cov-2 infection irrespectively of the age, diagnosis of RI during or after the onset of viral infection, and exclusion of other potential causes of thromboembolic event except of SARS-Cov-2. Patients with renal transplantation were also considered. Study criteria selection: after checking for relevance based on the title and the abstract, the full texts of the selected papers were retrieved and were further evaluated. Duplicated and irrelevant cases were excluded. Any disagreement was resolved by consensus with the involvement of a third reviewer. Quality of studies: The assessment of the quality case reports was based on four different domains: selection, ascertainment, casualty and reporting. Each paper was classified as "Good", "Moderate" and "Poor" for any of the four domains. Data extractions: Crucial data for the conduct of the study were extracted including: age, sex, time from SARS-Cov-2 infection till RI development, medical history, previous or current antithrombotic protection or treatment, laterality and degree of obstruction, other sites of thromboembolism, treatment for thromboembolism and SARS-Cov-2 and final outcome. DATA ANALYSIS methods of descriptive statistics were implicated for analysis and presentation of the data. RESULTS The systematic review retrieved 35 cases in 33 reports. In most cases, RI was diagnosed within a month from the SARSCov- 2 infection albeit 17 out of 35 patients were receiving or had recently received thromboprophylaxis. Right, left, bilateral and allograft obstruction was diagnosed in 7, 15, 8 and 5 patients respectively. 17 cases experienced additional extrarenal thromboembolism primarily in aorta, spleen, brain and lower limbs. Low molecular weight heparins (LMWH) (usually 60-80 mg enoxaparine bid) was the primary treatment, followed by combinations of unfractionated heparin and salicylic acid, apixaban and rivaraxaban, warfarin, acenocoumarol or clopidogrel. Kidney replacement therapy was offered to five patients while invasive therapies with thrombus aspiration or catheter directed thrombolysis were performed in two. Regarding the outcomes, five of the patients died. The total renal function was preserved in 17 cases and renal impairment with or without hemodialysis was recorded in 5 patients, two of them having lost their kidney allografts. LIMITATIONS The majority of included studies are of moderate quality. The results and the conclusions are based on case-reports only and crucial data are dissimilarly presented or missing through the relevant publications. CONCLUSIONS Thromboprophylaxis may not offer adequate protection against SARS-Cov-2 induced thrombosis. Most patients could be effectively treated with conservative measures, while in more severe cases aggressive treatment could be recommended. IMPLICATIONS OF KEY FINDINGS Therapeutic doses of LMWH could be considered for protection against RI in SARS-Cov-2 cases. Interventional treatment could be offered in a minority of more severe cases after carful balancing the risks and benefits.
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Affiliation(s)
- Diomidis Kozyrakis
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Georgios Kallinikas
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Anastasios Zarkadas
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Dimitris Bozios
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | | | - Georgios Charonis
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Konstantinos Safioleas
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Athanasios Filios
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Evangelos Rodinos
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Despoina Mytiliniou
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Gerasimos Vlassopoulos
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Ioannis Gkerzelis
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
| | - Panagiotis Filios
- Konstantopouleio General Hospital of Nea Ionia, Department of Urology, Nea Ionia, Attiki.
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18
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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19
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Kim DE, Moon I, Park S, Park M, Park S, Kwon SS, Kong MG, Park HW, Choi HO, Seo HS, Cho YH, Lee NH, Suh J. Temporal Trend of the Incidence and Characteristics of Renal Infarction: Korean Nationwide Population Study. J Korean Med Sci 2023; 38:e239. [PMID: 37550807 PMCID: PMC10412037 DOI: 10.3346/jkms.2023.38.e239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/04/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Large-scale studies about epidemiologic characteristics of renal infarction (RI) are few. In this study, we aimed to analyze the incidence and prevalence of RI with comorbidities in the South Korean population. METHODS We investigated the medical history of the entire South Korean adult population between 2013 and 2019 using the National Health Insurance Service database (n = 51,849,591 in 2019). Diagnosis of RI comorbidities were confirmed with International Classification of Disease, Tenth Revision, Clinical Modification codes. Epidemiologic characteristics, distribution of comorbidities according to etiologic mechanisms, and trend of antithrombotic agents were estimated. RESULTS During the 7-years, 10,496 patients were newly diagnosed with RI. The incidence rate increased from 2.68 to 3.06 per 100,000 person-years during the study period. The incidence rate of RI increased with age peaking in the 70s with 1.41 times male predominance. The most common comorbidity was hypertension, followed by dyslipidemia and diabetes mellitus. Regarding etiologic risk factor distribution, high embolic risk group, renovascular disease group, and hypercoagulable state group accounted for 16.6%, 29.1%, and 13.7% on average, respectively. For the antithrombotic treatment of RI, the prescription of antiplatelet agent gradually decreased from 17.0% to 13.0% while that of anticoagulation agent was maintained around 35%. The proportion of non-vitamin K antagonist oral anticoagulants remarkably increased from only 1.4% to 17.6%. CONCLUSION Considering the progressively increasing incidence of RI and high prevalence of coexisting risk factors, constant efforts to raise awareness of the disease are necessary. The current epidemiologic investigation of RI would be the stepping-stone to establishing future studies about clinical outcomes and optimal treatment strategies.
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Affiliation(s)
- Dong-Eon Kim
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Inki Moon
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Suyeong Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Minae Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Sojeong Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Seong Soon Kwon
- Division of Cardiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Min Gyu Kong
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Woo Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Nae Hee Lee
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jon Suh
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
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20
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Nguyen Tuan L, Nguyen Thi Bach Y, Nguyen Duc H, Nguyen Hoai V. A Massive Renal Infarction Due to Atheroemboli: A Case Report. Cureus 2023; 15:e41842. [PMID: 37575805 PMCID: PMC10423079 DOI: 10.7759/cureus.41842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
The symptoms of acute renal infarction (ARI) caused by atheroemboli are vague, making it rare. Early diagnosis of renal infarction can be made through contrast-enhanced CT of the abdomen. However, diagnosing atheroemboli is more challenging. Kidney biopsy is the most accurate method to determine the cause, but it may not always be available in clinical settings. In cases where a thrombectomy is performed, white substances in thrombus aspiration or the patient's blood can suggest a diagnosis. Intervention is an effective technique, but there is controversy due to a lack of data, particularly in lobular artery infarction. We successfully treated one case using thrombus aspiration, and the specimens suggested atherosclerosis as the cause.
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21
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Mizusugi M, Kenzaka T. Asymptomatic Idiopathic Renal Infarction Detected Incidentally on Contrast-Enhanced Computed Tomography: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1176. [PMID: 37374380 DOI: 10.3390/medicina59061176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Background: Renal infarction is an extremely rare disease. Although more than 95% of cases are symptomatic, there have been no previously reported asymptomatic cases, without any abnormal blood and urine test findings. Furthermore, the efficacy of long-term treatment of idiopathic renal infarction remains unknown. Case Presentation: A 63-year-old Japanese male underwent laparoscopy; a very low anterior resection of the rectum for lower rectal cancer (stage II) four years and five months prior to diagnosis with renal infarction. During the follow-up imaging studies, asymptomatic idiopathic renal infarction was found incidentally. The blood and urine test findings were normal. Contrast-enhanced computed tomography revealed a linearly bordered area of poor contrast in the dorsal region of the right kidney; however, no renal artery lesions, thromboembolic disease, or coagulation abnormalities were observed. Initial treatment with rivaroxaban 15 mg/day resulted in the remission of the infarcted lesion. The anticoagulation therapy was terminated after about 18 months without any incidences of re-infarction or bleeding events. Conclusions: We reported a very rare case of asymptomatic idiopathic renal infarction where blood and urine tests revealed no abnormal findings, and it was diagnosed incidentally during a post-treatment follow-up examination for lower rectal cancer. Long-term anticoagulant therapy for idiopathic renal infarction should be terminated at an appropriate time, taking the risk of bleeding into account.
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Affiliation(s)
- Mariko Mizusugi
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Hyogo, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Hyogo, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
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22
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Poggiali E, Ferrari MG, Botti C, Michieletti E, Vercelli A. Renal artery thrombosis. A case of acute flank pain in a patient with a new onset of renal failure and atrial fibrillation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023140. [PMID: 37326264 PMCID: PMC10308482 DOI: 10.23750/abm.v94i3.14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/17/2023]
Abstract
Renal artery thrombosis is a severe and often misdiagnosed entity, that represents a true medical emergency in which renal infarction can occur. The diagnosis is often a challenge for the emergency physicians since it can mimic other more common diseases, including renal colic. We report the case of an 82-year-old man who presented to our emergency department for abdominal pain, nausea, and vomiting resulting from right renal artery thrombosis and infarction caused by misdiagnosed atrial fibrillation. Starting from our experience, we recommend to always keep renal thromboembolism in the differential diagnosis in a patient with sudden onset of flank/abdominal pain, high levels of lactate dehydrogenase and/or haematuria since early diagnosis and proper treatment are the keys to rapid recovery.
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Affiliation(s)
| | | | - Camilla Botti
- Radiology Unit, Department of Radiological Functions, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Emanuele Michieletti
- Radiology Unit, Department of Radiological Functions, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Andrea Vercelli
- Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy .
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23
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Han S, Pradhan J, Girishkumar H. Rare renal embolic manifestation of left atrial myxoma: A case report. Int J Surg Case Rep 2023; 105:108118. [PMID: 37028188 PMCID: PMC10106462 DOI: 10.1016/j.ijscr.2023.108118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A complete occlusion of the renal artery due to atrial myxoma is a rare occurrence. CASE PRESENTATION Here we present a case of a completely occluded left renal artery caused by atrial myxoma emboli that presented with a 14-hour history of sudden onset sharp left flank pain radiating to the left lower quadrant of the abdomen, nausea, with preserved kidney function. Revascularization is unlikely to benefit the patient because it has been more than 6 h since the onset of ischemia. Anticoagulation therapy was initiated, followed by myxoma resection. The patient was discharged with no evidence of nephropathy. CLINICAL DISCUSSION Anticoagulation with or without thrombolysis is the standard treatment strategy for renal artery embolism. Given the delayed presentation of renal artery occlusion and the nature of the embolism, revisualization is not beneficial for this case. CONCLUSION Emboli of atrial myxoma caused renal artery occlusion is rare. Thrombolysis or surgical revascularization can be used to restore perfusion for renal artery embolism. However, the likelihood of benefit from revascularization must be assessed.
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Affiliation(s)
- Shiwei Han
- Department of Surgery, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jigyasha Pradhan
- Department of Surgery, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hanasoge Girishkumar
- Department of Surgery, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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24
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Aggarwal N, Rector D, Lazar N, Bukovec F. Venous thromboembolism with renal infarct due to paradoxical embolism. BMJ Case Rep 2023; 16:e252322. [PMID: 36977511 PMCID: PMC10069490 DOI: 10.1136/bcr-2022-252322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Paradoxical thromboembolism has variable presentation depending on site of embolisation. An African-American man in his 40s presented with severe abdominal pain, watery stools and exertional dyspnoea. At presentation, he was tachycardic and hypertensive. Labwork showed elevated creatinine with unknown baseline. Urinalysis showed pyuria. A CT scan was unremarkable. He was admitted with working diagnosis of acute viral gastroenteritis and prerenal acute kidney injury and supportive care was instituted. On day 2, the pain migrated to left flank. Renal artery duplex ruled out renovascular hypertension but showed a lack of distal renal perfusion. MRI confirmed a renal infarct with renal artery thrombosis. Transoesophageal echocardiogram confirmed a patent foramen ovale. Simultaneous arterial and venous thrombosis require hypercoagulable workup, including investigation for malignancy, infection or thrombophilia. Rarely, venous thromboembolism can directly cause arterial thrombosis by 'paradoxical thromboembolism'. Given the rarity of renal infarct, high index of clinical suspicion is necessary.
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Affiliation(s)
- Nishant Aggarwal
- Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
| | - Dana Rector
- Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, USA
| | - Nicholas Lazar
- Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
| | - Florian Bukovec
- Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
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Abi Doumet A, Bustos B, Garrell J, Salman M, Haider L. Fibromuscular Dysplasia Presenting as Acute Unilateral Renal Infarction: A Case Report and Review of Two Diseases. Cureus 2023; 15:e35933. [PMID: 37038580 PMCID: PMC10082588 DOI: 10.7759/cureus.35933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Fibromuscular dysplasia (FMD) is a rare systemic vascular disease that has been found to present as a renal infarction (RI) in only a handful of cases. We present a case of a 53-year-old Vietnamese patient presenting for sharp, severe left-sided abdominal pain of two-day duration associated with a migraine headache. On presentation, she was afebrile, and her vital signs were stable. Laboratory investigations were significant for mildly elevated leukocytosis but were otherwise normal. CT abdomen and pelvis with contrast revealed a left-sided renal infarct. The patient was then admitted to the hospital and started on therapeutic anticoagulation. A transthoracic echocardiogram was obtained and revealed no vegetation. CT angiography of the abdomen was pursued and was significant for mild beading within the mid-right and left renal arteries, consistent with fibromuscular dysplasia. Our patient was diagnosed with renal infarction in the setting of fibromuscular dysplasia, a combination that has been reported only a few times. Interestingly, our patient also had mild FMD based on imaging, making it even more of an unusual cause of renal infarction. This case highlights the connection between these two diseases and the need for more studies to characterize the association between them.
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26
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Thalmann NF, Rimensberger C, Blum MR, Liechti FD, Wertli MM. [Internal differential diagnoses in acute back pain : An internal perspective on the possible causes of acute back pain]. Z Rheumatol 2023; 82:3-9. [PMID: 36094629 PMCID: PMC9894948 DOI: 10.1007/s00393-022-01257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 02/06/2023]
Abstract
The majority of patients with acute back pain have no serious underlying disease; however, many internal diseases can be manifested as acute or chronic back pain. Therefore, in the assessment of patients with back pain the clinical history and clinical examination are important in order to detect indications for a possible underlying disease. Particularly red flags that indicate an acute or life-threatening disease should not be missed. In most cases where such red flags, risk factors or clinical indications are not present, no systematic search for internal underlying diseases is necessary. This article summarizes the most relevant differential diagnoses and clinical indications as well as warning symptoms.
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Affiliation(s)
- Nicolas F Thalmann
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz.
| | - Caroline Rimensberger
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
| | - Manuel R Blum
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern, Mittelstr. 43, 3012, Bern, Schweiz
| | - Fabian D Liechti
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
| | - Maria M Wertli
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
- Departement Innere Medizin, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Schweiz
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27
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Cambou L, Millet C, Terrier N, Malvezzi P, Timsit MO, Anglicheau D, Badet L, Morelon E, Prudhomme T, Kamar N, Lejay A, Perrin P, Uro-Coste C, Pereira B, Heng AE, Garrouste C, Guy L. Management and Outcome After Early Renal Transplant Vein Thrombosis: A French Multicentre Observational Study of Real-Life Practice Over 24 Years. Transpl Int 2023; 36:10556. [PMID: 37035106 PMCID: PMC10077970 DOI: 10.3389/ti.2023.10556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023]
Abstract
Early (<14 days) renal transplant vein thrombosis posttransplant (eRVTPT) is a rare but threatening complication. We aimed to assess eRVTPT management and the rate of functional renal transplantation. Of 11,172 adult patients who had undergone transplantation between 01/1997 and 12/2020 at 6 French centres, we identified 176 patients with eRVTPT (1.6%): 16 intraoperative (Group 1, G1) and 160 postoperative (Group 2, G2). All but one patient received surgical management. Patients in group G2 had at least one imaging test for diagnostic confirmation (N = 157, 98%). During the operative management of the G2 group, transplantectomy for graft necrosis was performed immediately in 59.1% of cases. In both groups, either of two techniques was preferred, namely, thrombectomy by renal venotomy or thrombectomy + venous anastomosis repair, with no difference in the functional graft rate (FGR) at hospital discharge (p = NS). The FGR was 62.5% in G1 and 8.1% in G2 (p < 0.001). Numerous complications occurred during the initial hospitalization: 38 patients had a postoperative infection (21.6%), 5 experienced haemorrhagic shock (2.8%), 29 exhibited a haematoma (16.5%), and 97 (55.1%) received a blood transfusion. Five patients died (2.8%). Our study confirms the very poor prognosis of early renal graft venous thrombosis.
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Affiliation(s)
- Ludivine Cambou
- Clermont-Ferrand University Hospital, Department of Urology, Clermont-Ferrand, France
| | - Clémentine Millet
- Clermont-Ferrand University Hospital, Department of Urology, Clermont-Ferrand, France
| | | | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Marc-Olivier Timsit
- Necker Hospital, Assistance Publique-Hôpitaux de Paris, Department of Urology, Paris, France
| | - Dany Anglicheau
- Necker Hospital, Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Kidney Transplantation, Paris, France
| | - Lionel Badet
- Service d’Urologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Morelon
- Service de Néphrologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Prudhomme
- Toulouse University Hospital, Department of Urology, Toulouse, France
| | - Nassim Kamar
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
- Toulouse University Hospital, Department of Nephrology, Toulouse, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Charlotte Uro-Coste
- Clermont-Ferrand University Hospital, Department of Nephrology, 3iHP, Clermont-Ferrand, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
| | - Anne Elisabeth Heng
- Clermont-Ferrand University Hospital, Department of Nephrology, 3iHP, Clermont-Ferrand, France
| | - Cyril Garrouste
- Clermont-Ferrand University Hospital, Department of Nephrology, 3iHP, Clermont-Ferrand, France
- *Correspondence: Cyril Garrouste,
| | - Laurent Guy
- Clermont-Ferrand University Hospital, Department of Urology, Clermont-Ferrand, France
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28
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Recovering from a renal vascular catastrophe: Case report. Clin Nephrol Case Stud 2023; 11:44-49. [PMID: 36896140 PMCID: PMC9990425 DOI: 10.5414/cncs110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/06/2023] [Indexed: 03/07/2023] Open
Abstract
Renal artery thrombosis is a rare vascular event that precipitates renal infarction. Although in up to one third of cases the etiology is not identified, renal artery lesions, cardioembolism and acquired thrombophilias are the main causes. A bilateral simultaneous idiopathic renal artery thrombosis is an unlikely coincidence. We present two cases of patients with acute bilateral renal artery thrombosis of unknown etiology. Cardiac embolism, acquired thrombophilia and occult neoplasm workups were negative. Both cases were temporarily hemodialysis-dependent and partially recovered renal function under conservative approach with systemic anticoagulation. Recommendations on optimal treatment for renal artery thrombosis are still lacking. We discuss the available options.
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29
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Taner S, Turgut EA, Akkaya E, Cil M, Celik U. An extremely rare cause of flank pain: Answers. Pediatr Nephrol 2023; 38:1041-1044. [PMID: 35748942 PMCID: PMC9243794 DOI: 10.1007/s00467-022-05666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sevgin Taner
- Department of Pediatric Nephrology, Adana City Training and Research Hospital, Adana, Turkey.
| | - Elif Afat Turgut
- Department of Pediatric Infectious Disease, Adana City Training and Research Hospital, Adana, Turkey
| | - Elif Akkaya
- Department of Pediatrics, Nusaybin State Hospital, Nusaybin, Turkey
| | - Metin Cil
- Department of Pediatric Hematology and Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | - Umit Celik
- Department of Pediatric Infectious Disease, Adana City Training and Research Hospital, Adana, Turkey
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30
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Woo S, Lee CA, Lee JW, Moon J, Cho YS, Nah S, Han S. Predictors for Distinguishing Renal Infarction From Urolithiasis in the Emergency Department: A Randomly Matched Retrospective Case-Control Study. J Emerg Med 2023; 64:31-39. [PMID: 36641258 DOI: 10.1016/j.jemermed.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Emergency department (ED) clinicians may misdiagnose renal infarction (RI) as urolithiasis because RI is a rare disease with presenting symptoms similar to the symptoms of urolithiasis. However, earlier diagnosis of RI can improve patient prognosis. OBJECTIVES We investigated potential predictors for distinguishing RI from urolithiasis based on clinical findings and laboratory results. METHODS This randomly matched retrospective case-control study included patients who had been diagnosed with acute RI or acute urolithiasis between January 2016 and March 2020. Patients were excluded if they were aged under 18 years, had a history of trauma, or had incomplete medical records. Using a matching ratio of 1:4, RI patients were randomly matched to urolithiasis patients. Multivariable logistic regression was performed to identify factors that could distinguish RI from urolithiasis. RESULTS In total, 48 patients were included in the RI group and 192 patients were included in the urolithiasis group. Multivariable logistic regression showed that age ≥ 65 years (odds ratio [OR] 6.155; p = 0.022), atrial fibrillation (OR 18.472; p = 0.045), current smoking (OR 17.070; p = 0.001), costovertebral angle tenderness (OR 0.179; p = 0.037), aspartate aminotransferase level ≥ 27.5 U/L (OR 6.932; p = 0.009), sodium level ≥ 138.5 mEq/L (OR 0.079; p = 0.004), and hematuria (OR 0.042; p = 0.001) were significant predictors that could distinguish RI from urolithiasis. Based on these results, a nomogram was constructed. CONCLUSION Age ≥ 65 years, atrial fibrillation, current smoking, absence of costovertebral angle tenderness, aspartate aminotransferase level ≥ 27.5 U/L, sodium level < 138.5 mEq/L, and absence of hematuria were predictors that can distinguish between RI and urolithiasis.
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Affiliation(s)
- Seungho Woo
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Choung Ah Lee
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jae Wook Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jieun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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31
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Al‐sadi A, Abdulgayoom M, Alamin M, Kolleri J, Jawarneh I, Almaharmeh Q. Renal infarction in a patient with thyrotoxicosis-induced atrial fibrillation treated successfully with dabigatran, a case report and literature review. Clin Case Rep 2022; 10:e6693. [PMID: 36483878 PMCID: PMC9723477 DOI: 10.1002/ccr3.6693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Renal infarction is an underdiagnosed condition with multiple possible causes, including atrial fibrillation. The treatment approach includes percutaneous endovascular therapy (PET) to restore blood flow, antiplatelet therapy, anticoagulation, or combination therapy, depending on the patient's status and available modalities. Warfarin is the standard anticoagulation therapy, although direct oral anticoagulation (DOAC) therapy is getting more popular. Here, we present a 60-year-old male patient with hyperthyroidism complicated by acute renal infarction, which was successfully treated with dabigatran, evident by non-recurrence and restoration of blood flow in a follow-up CT angiogram. This case report may open the door for the use of DOAC in acute renal infarction though more studies are needed to prove the efficacy.
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Affiliation(s)
- Anas Al‐sadi
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | | | - Mohammed Alamin
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Jouhar Kolleri
- Department of RadiologyHamad Medical CorporationDohaQatar
| | - Israa Jawarneh
- Department of Internal MedicineKing Abdullah University HospitalIrbidJordan
| | - Qusai Almaharmeh
- Department of Internal MedicineSaint Michael's Medical CenterNewarkNew JerseyUSA
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32
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Gourd NM, Jenkins HE, Miles R, Lee A, Mason J, Connor A. Catastrophic Fibromuscular Dysplasia Presenting with Concomitant Bilateral Renal Infarction, Vertebral Artery Dissection, and Mesenteric Ischaemia. Case Rep Nephrol Dial 2022; 12:255-261. [PMID: 36654984 PMCID: PMC9841787 DOI: 10.1159/000527438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disorder of the arterial wall muscular layer which can lead to arterial stenosis, occlusion, and dissection. Clinical presentations of FMD vary depending on the arterial territories involved, often leading to diagnostic challenges. This case report describes an exceptionally unusual presentation of FMD, not previously described, affecting a previously fit and well 37-year-old female presenting with bilateral renal infarction, sequential vertebral artery dissections, mesenteric ischaemia, and the requirement for continued renal replacement. This report highlights how unusual presentations of FMD can mask the underlying diagnosis. Early consideration of FMD in a differential diagnosis can guide an effective management strategy, including appropriate imaging and multi-speciality involvement.
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Affiliation(s)
- Nicholas Martin Gourd
- Renal Department, University Hospitals Plymouth, Plymouth, UK,*Nicholas Martin Gourd,
| | | | - Richard Miles
- Renal Department, University Hospitals Plymouth, Plymouth, UK
| | - Adrienne Lee
- Renal Department, University Hospitals Plymouth, Plymouth, UK
| | - Justin Mason
- Professor of Vascular Rheumatology, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Connor
- Renal Department, University Hospitals Plymouth, Plymouth, UK
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33
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Almatrafi MA, Kabli AF, Subahi Y, Yaseen E, Alsahaf N, Alidrisi D, Ahmed HA, Masmali HM, Alahmad O, Khan MN, Minshawi F. A Rare Case of a Child Diagnosed With Multisystem Inflammatory Syndrome After COVID-19 Presenting With Renal Infarctions and Transient Blast Cells: A Case Report and Literature Review. Cureus 2022; 14:e30832. [DOI: 10.7759/cureus.30832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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Ge T, Zhu Z, Wang J, Zhou W, Song EJ, Tang S. A rare cause of abdominal pain managed unconventionally: acute renal infarction caused by atrial fibrillation: a case report. J Med Case Rep 2022; 16:381. [PMID: 36258245 PMCID: PMC9580199 DOI: 10.1186/s13256-022-03608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation is one of the most common arrhythmias. The main thrombotic complication of arterial fibrillation is ischemic stroke, but it can also cause acute renal infarction from embolization. The low incidence and nonspecific clinical manifestations of acute renal infarction make it difficult to diagnose, often leading to either delayed diagnosis or misdiagnosis. Due to its rarity, more efficient treatment guidelines are helpful for the management of acute renal infarction related to the thromboembolic complication of arterial fibrillation. CASE REPORTS We report a case of acute renal infarction due to underlying arterial fibrillation, where a novel interventional therapeutic method was used. A 66-year-old Chinese man with arterial fibrillation, not on anticoagulation due to the patient's preference, and coronary artery disease post-percutaneous coronary intervention to left anterior descending artery about 1 year ago, was currently on dual antiplatelet therapy. He suddenly developed intermittent and sharp left-sided abdominal pain and was found to have an acute left renal infarction on computed tomography scan. Angiogram showed acute occlusion of the left renal artery due to thromboembolism. For this patient, a combination method of local thrombus aspiration, angioplasty, and infusion of nitroglycerin and diltiazem were used, restoring blood flow to the left kidney. After recovery, the patient was discharged on aspirin, clopidogrel, and warfarin. At 6 months follow-up, there was no residual kidney dysfunction. CONCLUSIONS Acute renal infarction from thromboembolism is a rare but serious complication of arterial fibrillation. More efficient and different options for intervention methods will benefit the treatment of this disease. Here, we report a combination therapeutic method that has not been used in acute renal infarction associated with arterial fibrillation, and which restored renal perfusion and prevented long-term kidney injury.
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Affiliation(s)
- Tao Ge
- Department of Cardiology, The First Affiliated Hospital, Wannan Medical College, No.2, Zhe Shan West Road, Wuhu, 241001, Anhui, China
| | - ZhengCai Zhu
- Department of Cardiology, The First Affiliated Hospital, Wannan Medical College, No.2, Zhe Shan West Road, Wuhu, 241001, Anhui, China
| | - Jinfeng Wang
- Department of Cardiology, The First Affiliated Hospital, Wannan Medical College, No.2, Zhe Shan West Road, Wuhu, 241001, Anhui, China
| | - Wenjiao Zhou
- Department of Electrocardiogram, The First Affiliated Hospital, Wannan Medical College, Wuhu, Anhui, China
| | - Evelyn J Song
- Division of Cardiology, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Shengxing Tang
- Department of Cardiology, The First Affiliated Hospital, Wannan Medical College, No.2, Zhe Shan West Road, Wuhu, 241001, Anhui, China.
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35
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Lemos Mendes MF, Ribeiro B, Barros D, Rodrigues F, Marques S. Bilateral Renal Artery Thrombosis: A Case of Successful Kidney Recovery After Prolonged Anuria. Cureus 2022; 14:e30087. [DOI: 10.7759/cureus.30087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
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36
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Arterial Thrombotic Complications in COVID-19: A Case of Renal Infarction. Biomedicines 2022; 10:biomedicines10102354. [PMID: 36289613 PMCID: PMC9598528 DOI: 10.3390/biomedicines10102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 infection has been associated with thrombotic complications, especially venous thromboembolism. Although arterial thrombotic complications are rarely seen in these patients, we report the case of a 43-year-old patient who developed thrombosis of the main branch of the left renal artery, causing partial infarction of the left kidney associated with severe pain. He had no risk factors for thrombosis except for COVID-19 infection. We excluded any possible condition usually associated with renal artery thrombosis/embolism (i.e., cardiovascular, oncological, hematological, or rheumatic). The thrombosis resolved after a combination of anticoagulant and anti-platelet therapy. This case highlights the importance of the risk of recurrence of thrombosis in patients with a recent history of COVID-19, even after hospital discharge, improvement of the initial thrombotic event, and clearance of SARS-CoV-2 infection.
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37
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Lee NA, Jeong ES, Jang HS, Park YC, Kang JH, Kim JC, Jo YG. Antiphospholipid syndrome with renal and splenic infarction after blunt trauma: A case report. World J Clin Cases 2022; 10:9404-9410. [PMID: 36159402 PMCID: PMC9477667 DOI: 10.12998/wjcc.v10.i26.9404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/12/2022] [Accepted: 08/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In trauma patients, bleeding is an immediate major concern. At the same time, there are few cases of acute vascular occlusion after blunt trauma, and it is unclear what assessment and diagnosis should be considered for these cases. Herein, we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.
CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago. He had no medical history. Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen. Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion. Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk, additional laboratory tests were performed to evaluate hypercoagulability. The results suggested a high possibility of antiphospholipid syndrome. Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks. The diagnosis was confirmed, and he continued to visit the rheumatology outpatient clinic while taking warfarin.
CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion, especially in young patients with low cardiovascular risk.
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Affiliation(s)
- Na-A Lee
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
| | - Eui-Sung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
| | - Hyun-Seok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
| | - Yun-Chul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
| | - Ji-Hyoun Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
| | - Jung-Chul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
| | - Young-Goun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
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38
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Vasquez Espinosa WA, Santos Argueta A, Hurtado Tandazo VA, Vasquez Espinosa CF. A Case Report of a Young Female With Renal Infarction Secondary to Breakthrough COVID Infection. Cureus 2022; 14:e25527. [PMID: 35800811 PMCID: PMC9245587 DOI: 10.7759/cureus.25527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 infection is a disease that induces a hypercoagulable state that appears to be more aggressive than other conditions related to endothelial damage. The kidney, a highly vascularized organ rich in Angiotensin-Converting Enzyme 2 (ACE2) receptors, is commonly affected by COVID-19 infection. Acute kidney injury (AKI) is common in these patients and has been linked to worse outcomes. Furthermore, kidney infarction, although uncommon, has also been reported. We present the case of a 21-year-old otherwise healthy female presenting with flank pain who was found to have renal infarction in the setting of breakthrough COVID-19 infection and Oral contraceptive pill (OCP) use. Despite getting appropriate vaccination, the patient was infected. She was not hypoxic, and her kidney function was preserved. CT angiography demonstrated peripheral hypoattenuation in the right kidney compatible with infarct but no evidence of a thrombus. The patient was medically managed with anticoagulation, and supportive therapy was offered for pain control. She had clinical improvement. The follow-up at three weeks showed normal renal function. She was continued with novel oral anticoagulation (NOAC). This case demonstrates that COVID-19 infection may present renal infarction in otherwise healthy young individuals even after appropriate vaccination. Early recognition is essential so that appropriate therapy can be given. Long-term anticoagulation and outcomes of this entity must be studied.
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39
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Zhang K, Panisurya T, Srinivasan A, Khawaja H, Qadri A, Ali Z. Cardioembolic-related renal infarction. Proc AMIA Symp 2022; 35:529-530. [DOI: 10.1080/08998280.2022.2065085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Keven Zhang
- Department of Medicine, University of Houston/HCA Kingwood Medical Center, Kingwood, Texas
| | - Tushar Panisurya
- Department of Medicine, University of Houston/HCA Kingwood Medical Center, Kingwood, Texas
| | - Aswin Srinivasan
- Department of Medicine, University of Houston/HCA Kingwood Medical Center, Kingwood, Texas
| | - Harris Khawaja
- Department of Medicine, University of Houston/HCA Kingwood Medical Center, Kingwood, Texas
| | - Ahmed Qadri
- Department of Medicine, University of Houston/HCA Kingwood Medical Center, Kingwood, Texas
| | - Zuhair Ali
- Department of Medicine, University of Houston/HCA Kingwood Medical Center, Kingwood, Texas
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40
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[42/m-Unexplained flank pain : Preparation for the medical specialist examination: part 151]. Internist (Berl) 2022; 63:290-293. [PMID: 35357508 PMCID: PMC8968305 DOI: 10.1007/s00108-022-01319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 12/02/2022]
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41
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Weise L, Chiapaikeo D, Tan TW, Weinkauf C, Goshima KR, Zhou W. Role of late renal revascularization in functional renal salvage. J Vasc Surg Cases Innov Tech 2022; 8:121-124. [PMID: 35243188 PMCID: PMC8857538 DOI: 10.1016/j.jvscit.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
The duration that renal parenchyma will tolerate ischemia has continued to be debated. We have reported the cases of three patients who had undergone revascularization procedures with successful return of baseline renal function after prolonged renal artery occlusion of 14 days to 3 months. These cases highlight that aggressive revascularization can lead to successful renal salvage in selected patients. We examined the characteristics of these patients and those of others in the literature and reviewed the factors favoring recovery.
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Affiliation(s)
| | | | | | | | | | - Wei Zhou
- Correspondence: Wei Zhou, MD, Division of Vascular Surgery, Department of Surgery, University of Arizona, 1601 N Campbell Ave, Tucson, AZ 85724
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42
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Lin JW, Tsai JH, Huang CH, Lin TK. Early Diagnosis and Intervention of Acute Renal Infarction with Catheter-Directed Thrombolytic Therapy. ACTA CARDIOLOGICA SINICA 2022; 38:134-140. [PMID: 35273434 PMCID: PMC8888322 DOI: 10.6515/acs.202203_38(2).20210925a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute renal infarction is a rare and under-diagnosed disease for which the optimal treatment is unknown. OBJECTIVES This study aimed to determine the utility of catheter-directed thrombolysis (CDT) to treat acute renal infarction. METHODS From November 2010 to September 2017, 13 patients with acute renal infarction were treated with CDT. The diagnosis was confirmed by contrast-enhanced computed tomography and renal angiography. RESULTS The most common symptoms and signs were flank pain (53.8%) and abdominal pain (30.8%). More than two-thirds of the patients (69.2%) had atrial fibrillation. In successful reperfusion cases, the median time from symptom onset to diagnosis was 6 hours, and the average time from diagnosis to treatment was 3.5 hours. Complete resolution of thrombi in the renal artery was achieved in 10 of the 13 patients (76.9%) and partial resolution in two patients (15.4%). Only one patient (7.7%) failed to respond to treatment. Compared with admission, renal function was significantly improved at 6 months. No major complications occurred during the course of CDT therapy. CONCLUSIONS CDT offers an alternative to surgical intervention and can achieve good angiographic results with an early diagnosis and intervention. It is relatively safe and can restore at least partial renal function.
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Affiliation(s)
- Jiunn-Wen Lin
- Division of Cardiology, Department of Internal Medicine
| | | | - Chien-Hsiu Huang
- Division of Chest, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi
| | - Tin-Kwang Lin
- Division of Cardiology, Department of Internal Medicine;
,
School of Medicine, Tzu Chi University, Hualien, Taiwan
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43
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Lim JL, Lau KK, Lim AKH. Successful rescue from kidney failure with delayed catheter-directed intervention after catastrophic bilateral kidney paradoxical thromboembolism. BMJ Case Rep 2022; 15:15/2/e246885. [PMID: 35144961 PMCID: PMC8845175 DOI: 10.1136/bcr-2021-246885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 62-year-old man presented with acute abdominal and flank pain, oligoanuria and severe acute kidney injury. Unenhanced CT imaging did not detect urolithiasis or hydronephrosis. There was an early blood pressure surge followed by an intense inflammatory response, with a rise in peripheral blood leucocytes and C reactive protein. His urinalysis was bland but the serum lactate dehydrogenase was markedly elevated. CT angiograms demonstrated multiple pulmonary emboli and bilateral renal artery thromboembolism, with occlusion of the left main renal artery. Despite an 88-hour delay from pain onset, catheter-directed thrombolysis and thromboaspiration of both renal arteries were successfully performed, allowing the patient to recover enough kidney function to cease haemodialysis. A patent foramen ovale with right-to-left shunting was discovered, and paradoxical embolism was suspected as the cause of renal infarction. The benefit of catheter-directed reperfusion after prolonged bilateral renal ischaemia is not easily predicted by the severity or duration of acute kidney injury alone.
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Affiliation(s)
- Jing Loong Lim
- General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Kenneth K Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia.,Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Andy K H Lim
- Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia .,General Medicine and Nephrology, Monash Health, Clayton, Victoria, Australia
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44
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Kolachana SM, Janvier A. Acute Renal Infarction Heralds New-Onset Paroxysmal Atrial Fibrillation. Cureus 2022; 14:e21554. [PMID: 35223324 PMCID: PMC8865364 DOI: 10.7759/cureus.21554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
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45
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Khokhar S, Garcia D, Thirumaran R. A rare case of renal infarction due to heroin and amphetamine abuse: case report. BMC Nephrol 2022; 23:28. [PMID: 35021999 PMCID: PMC8756614 DOI: 10.1186/s12882-021-02642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background Renal infarctions as a result of recreational drug use are rare and are commonly associated with cocaine use. Although amphetamines have a similar mechanism of action as cocaine, there are few reports linking them to ischemic events, and only one to renal infarction. Similarly, few reports link heroin use with infarcts, but never in the kidney. Although uncommon, several mechanisms have been implicated in heroin and amphetamine-induced infarction, including vasculopathy, vasculitis and the activation of the coagulation cascade. Case Presentation 47-year-old female with a past medical history of non-intravenous heroin and amphetamine abuse, chronic obstructive pulmonary disease, hypertension, hyperlipidemia presented with right lower extremity swelling and rash, which was diagnosed as cellulitis and treated appropriately. Incidentally, the patient was found to have an acute kidney injury and further workup identified multiple renal infarcts in the right kidney. The patient had no past medical history of clotting disorders. Blood culture and urine cultures were sterile; autoimmune and hypercoagulable workup were negative. Urinalysis was unremarkable. Urine toxicology was only positive for opiates and amphetamines, which were thought to be the most likely cause of the renal infarct. Patient was lost to outpatient follow up due to noncompliance, but returned to the hospital for re-emergence of her cellulitis, during which no new infarcts were discovered, and the previous renal infarct had scarred over. Conclusion There are very few reports of heroin and amphetamine-induced infarctions. This case report describes a rare but important complication of heroin/amphetamine abuse that could be easily overlooked.
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46
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Lai YH, Chuang CH, Ho SW, Chen CC. Usage of Point-of-care Ultrasonography for Rapid Diagnosis of Acute Renal Infarction: Two Case Reports. J Med Ultrasound 2022; 30:300-302. [PMID: 36844771 PMCID: PMC9944825 DOI: 10.4103/jmu.jmu_167_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022] Open
Abstract
Acute renal infarction is a rare form of vascular emergency. Although major risk factors of renal infarction are due to cardio-embolic events such as atrial fibrillation, valvular or ischemic heart disease, renal artery thrombosis/dissection, and coagulopathy, the prevalence of idiopathic acute renal infarction can be as high as 59%. Two cases that contributed to this emergency are presented. The history, physical examination, and clinical imaging findings for clinical assessment are briefly described. Point-of-Care Ultrasonography (POCUS) was used to exclude other etiology and identify the pathological changes. The role of POCUS in rapid rule in acute renal infarction has been emphasized in clinical settings.
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Affiliation(s)
- Yi-Hsin Lai
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Cheng-Hsun Chuang
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Sai-Wai Ho
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Chia-Ching Chen
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan,Address for correspondence: Dr. Chia-Ching Chen, Department of Emergency Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Road, South Dist., Taichung City 402, Taiwan. E-mail:
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47
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Sutthigran S, Saisawart P, Klaengkaew A, Horoongruang K, Chaivoravitsakul N, Komin K, Thanaboonnipat C, Choisunirachon N. Use of contrast-enhanced computed tomography to detect kidney infarction in dogs. J Vet Intern Med 2021; 36:164-170. [PMID: 34953007 PMCID: PMC8783343 DOI: 10.1111/jvim.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Kidney infarction is a renovascular disease diagnosed by contrast‐enhanced computed tomography (CECT) in humans. Objectives To describe the frequency of kidney infarction and to determine the detection of kidney infarction with CECT in dogs. Animals Eight hundred and twenty‐six abdominal CECT studies of 826 dogs. Methods A cross‐sectional retrospective study. Dogs with abdominal CT scans including CECT were retrospectively retrieved. Kidney infarction was classified into 3 grades based on the extent of infarction relative to total kidney area. The location and number of kidney infarctions in each kidney were expressed as number and percentage. The ability of visualization of kidney infarction in each multiplanar reconstruction (MPR) image plane was evaluated by agreement of 2 observers. Results The frequency of kidney infarction in dogs was 3.15% (26/826 dogs; 95% CI = 2.05‐4.61). Most kidney infarctions were classified as grade 1, or the lesions were less than 25% of the kidney (47/56, 83.93%) and most were detected at the caudal pole of the kidney (31/56, 55.35%) on the sagittal plane. On MPR image planes, the sagittal plane had the highest proportion (34/56, 60.71%) of excellent visual category to detect kidney infarction. Conclusions and Clinical Importance The CECT, especially the sagittal plane, is a useful diagnostic tool for the detection of kidney infarction in dogs.
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Affiliation(s)
- Somchin Sutthigran
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Phasamon Saisawart
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Auraiwan Klaengkaew
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kongthit Horoongruang
- Small Animal Teaching Hospital, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nardtiwa Chaivoravitsakul
- Small Animal Teaching Hospital, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kiatpichet Komin
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Chutimon Thanaboonnipat
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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48
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Al-Shareef AS, Alwafi E, Alzailaie M, Shirah B. Idiopathic Renal Infarction: An Important Differential Diagnosis of Unexplained Flank Pain. Cureus 2021; 13:e18206. [PMID: 34722022 PMCID: PMC8544645 DOI: 10.7759/cureus.18206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Abstract
Unexplained flank pain should alert physicians regarding the possibility of acute renal infarction. Despite its rare occurrence, prompt diagnosis and management of renal infarction can improve outcomes. We report a previously healthy 37-year-old male who presented to the emergency department complaining of left flank pain. Computed tomography angiogram showed a thrombus in the left renal artery. The patient responded well to treatment with anticoagulation, and the symptoms resolved. The present case conforms with other experiences of good outcomes when treatment is initiated in a timely manner. Anticoagulation led to resolution of the thrombus and restoration of perfusion. This case report should remind physicians to consider renal infarction in the differential diagnosis of an acute abdomen patient with no risk factors.
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Affiliation(s)
- Ali S Al-Shareef
- Emergency Medicine, King Abdulaziz Medical City, Jeddah, SAU.,Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Emad Alwafi
- Internal Medicine, King Abdulaziz Medical City, Jeddah, SAU.,Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mohammed Alzailaie
- Critical Care Medicine, King Abdulaziz Medical City, Jeddah, SAU.,Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Bader Shirah
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
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49
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Al‐Mashdali AF, Alwarqi AF, Elawad SM. Simultaneous renal infarction and splenic infarction as a possible initial manifestation of COVID-19: A case report. Clin Case Rep 2021; 9:e04819. [PMID: 34765194 PMCID: PMC8572341 DOI: 10.1002/ccr3.4819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022] Open
Abstract
We recommend testing for SARS-CoV-2 in a patient with an unexplained thromboembolic event, even in the absence of fever or respiratory symptoms.
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50
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Papazoglou DD, Weiss S, Kissling P. [Rare cause of renal infarction in a 28-year-old male patient]. Internist (Berl) 2021; 63:221-223. [PMID: 34654934 PMCID: PMC8518887 DOI: 10.1007/s00108-021-01186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
Es wird über den Fall eines 28-jährigen Patienten mit einem Niereninfarkt aufgrund eines embolisierenden Aneurysmas nach traumatischer Dissektion einer Nierensegmentarterie berichtet. Er stellte sich 1,5 Jahre nach einem Motorradunfall mit Abdominal- und Flankenschmerzen vor. C‑reaktives Protein und Laktat-Dehydrogenase waren erhöht. Die Diagnose wurde mittels computertomographischer Angiographie gestellt. Weitere Ursachen eines Niereninfarkts wurden ausgeschlossen. Nach interdisziplinärer Besprechung entschieden wir uns bei jungem und sportlich aktivem Patienten für ein interventionelles Coiling, um eine langfristige Antikoagulation zu vermeiden.
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Affiliation(s)
- Dimitrios David Papazoglou
- Departement Chirurgie, Gefässzentrum soH, Bürgerspital Solothurn, Schöngrünstraße 42, 4500, Solothurn, Schweiz.
| | - Salome Weiss
- Universitätsklinik für Herz- und Gefässchirurgie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Pascal Kissling
- Departement Chirurgie, Gefässzentrum soH, Bürgerspital Solothurn, Schöngrünstraße 42, 4500, Solothurn, Schweiz
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