Acute Renal Infarction Heralds New-Onset Paroxysmal Atrial Fibrillation.

Sindhura M Kolachana,Adrien Janvier

doi:10.7759/cureus.21554

Sindhura M Kolachana, Adrien Janvier

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https://doi.org/10.7759/cureus.21554

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Journal: Cureus	Publication Date: Jan 24, 2022
License type: cc-by

Affiliation: Georgetown University

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Acute renal infarcts may be asymptomatic or occur with flank pain, nausea, vomiting, or hematuria. Given the non-specific symptomatology, many acute renal infarcts are misdiagnosed or not diagnosed at all. Most are diagnosed with contrast-enhanced computed tomography. A high index of suspicion should be maintained, especially for patients with cardiovascular risk factors. A negative workup for the etiology of a renal infarction should prompt cardiac monitoring for paroxysmal atrial fibrillation because this is the primary etiology in up to one-third of cases. Treatment of atrial fibrillation reduces the risk of recurrent renal infarction as well as stroke. Early diagnosis of acute renal infarction in a select group of patients may allow for endovascular intervention to re-establish vascular patency. Here, we review the case of a 43-year-old man with no significant medical history who presented with flank pain in the setting of an acute renal infarct.

Highlights

An acute renal infarction occurs predominantly when a renal artery or any of its branches is blocked
Diagnosis of acute renal infarction in a select group of patients may allow for endovascular intervention to re-establish vascular patency
Atrial fibrillation is more commonly associated with an increased risk of stroke; there are several reports of acute renal infarction caused by atrial fibrillation

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Introduction

An acute renal infarction occurs predominantly when a renal artery or any of its branches is blocked. A 43-year-old man with a history of asthma and a recently treated community-acquired pneumonia infection presented to the emergency room with a one-day history of worsening lower abdominal pain, nausea, and vomiting. Given that the imaging findings were consistent with a thrombosed left inferior renal artery and associated left lower pole kidney infarction, a heparin drip was initiated. He was placed on telemetry empirically, and we incidentally noted an episode of atrial fibrillation lasting approximately two hours (heart rate, 130s) with spontaneous conversion to sinus rhythm. He was stabilized on metoprolol and warfarin therapy and advised to follow up with cardiology

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