Renal infarction

Renal infarction is a medical condition caused by an abrupt disruption of the renal blood flow in either one of the segmental branches or the major ipsilateral renal artery. Patients who have experienced an acute renal infarction usually report sudden onset flank pain, which is often accompanied by fever, nausea, and vomiting.

The primary causes of renal infarction are hypercoagulable conditions, renal artery damage (usually brought on by arterial dissection), and cardioembolic illness.

Signs and symptoms
The most common symptoms of a renal infarction are acute onset flank pain, fever, nausea, and vomiting. This may be accompanied by an abrupt rise in blood pressure, most likely due to renin mediation. Rarely oliguria will be present.

Complications
Complications include acute kidney injury that can progress to chronic kidney disease.

Causes
Acute renal infarction is mostly caused by two major causes: in situ renal artery thrombosis, which is less common, and thromboemboli, which typically results from thrombus in the heart or aorta.

Risk factors
Atrial fibrillation, a prior embolism history, mitral stenosis, diabetes, hypertension, and ischemic heart disease are risk factors for renal infarction.

Diagnosis
Most patients have been reported to have gross or microscopic hematuria. Significantly increased serum lactate dehydrogenase levels and proteinuria may also be observed. Renal angiography is still the gold standard, but CT renal angiography, CT angiography, and DMSA radioisotope scan can also be used to establish the diagnosis.

Treatment
There are no comparative trials to determine the best course of action for renal infarction brought on by thromboemboli, in situ thrombosis, or renal artery dissection. Reported treatments include open surgery, endovascular therapy, endovascular therapy (thrombolysis/thrombectomy with or without angioplasty), and anticoagulation.

Outlook
Renal infarction 30-day mortality was 11.4% in a retrospective analysis of 44 individuals with atrial fibrillation and renal infarction.

Epidemiology
In 1940, a study of 14,411 autopsies revealed that 1.4% of the cases involved renal infarction.

A retrospective study that was carried out during a 36-month observation period revealed that the incidence of renal infarction among patients who visit the ED was 0.007%.