Sudden loss of consciousness and right flank pain associated with renal infarction.

Abstract

While at home, a 77-year-old woman with atrial fibrillation (Af), coronary artery disease, hypertension and a 10-year history of hyperlipidaemia experienced a loss of consciousness combined with sudden onset of right flank pain and fell on the ground. She was brought to our hospital where brain computerized tomography (CT) revealed an acute infarction over the left middle cerebral artery and posterior cerebral artery. Electrocardiography showed Af with a ventricular rate of 116 beats per minute. Her blood pressure was 130/70 mmHg, and her heart beat was irregular. She had normal pupil size and light reflex. There was a throbbing pain over her right costo-vertebral angle but no local abdominal tenderness was seen. No bruit was heard. Her white blood cell count was 20420/cumm, haemoglobin 12.5 g/dL and platelets 208 × 103/cumm. Her serum lactate dehydrogenase was 1000 IU/dL, creatinine 2.1 mg/dL, urea nitrogen 24 mg/dL and potassium 3.2 mmol/L. Urine analysis revealed protein 2+, red cell 2–5/ high power field (HPF) and white cell 1–3/ HPF. Markers for anticardiolipin antibody, lupus anticoagulant, anti-thrombin III, and protein C and S were unremarkable. Abdominal contrast with CT revealed a markedly less-enhanced right renal parenchyma (Figure 1). An enhancement of the left kidney was also noted. There were no stones and no perinephric inflammatory stranding. Renal arterial angiography (Figure 2A) revealed total occlusion of the right renal artery and