Acute Renal Infarction Research Articles

Acute Renal Infarction: A 12-Year Retrospective Analysis

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.

A Case of Acute Renal Infarct Secondary to Protein S Deficiency

Renal infarction is an underdiagnosed and underreported condition with multiple etiologies. A 45-year-old man presented with acute pain in the right lumbar region, CT scan showed a wedge shaped, non-enhancing, hypodense lesion in the cortex of the upper pole of the right kidney- suggestive of infarct. A pro-thrombotic workup revealed a protein S deficiency and a heterozygous mutation for MTHFR gene. Protein S is a vitamin-K dependent plasma glycoprotein, the deficiency of which is associated with a hypercoagulable state, which in turn led to renal infarction in this patient.

Fibromuscular Dysplasia: Renal Artery Dissection and Infarction in a Young Male

Fibromuscular dysplasia is an abnormal cell growth of the arterial wall that usually affects the renal and carotid arteries. It may lead to stenosis, tortuosity, aneurysm, or dissection of the artery and can potentially compromise the circulation from ensuing total occlusion and infarction of the recipient area. We report a case of a young male who presented with severe acute abdominal pain in the right side of the abdomen associated with nausea, vomiting, and constipation. Computed tomography of the abdomen with intravenous contrast showed acute renal infarction of a focal area at the lower pole of the right kidney, subsequent computed angiography showed dissection of a segmental branch of the right renal artery associated with fibromuscular dysplasia and beading appearance of the right renal artery. The renal function test and urinalysis were both normal. The patient was treated with unfractionated heparin infusion, with the resolution of abdominal pain, he was subsequently discharged home uneventfully on oral aspirin.

WCN24-2492 Acute renal infarction in a 52-year-old man using testosterone for muscle mass increase

WCN24-2492 Acute renal infarction in a 52-year-old man using testosterone for muscle mass increase

Rare Case of Acute Renal Artery Thrombosis in Nephrotic Syndrome: The Unusual Presentations and Outcomes of Endovascular Manual Aspiration Thrombectomy

Renal artery thrombosis is a rare condition that requires early diagnosis and urgent intervention to prevent renal infarction and permanent renal damage. Possibility of renal artery thrombosis should be considered in patients with underlying hypercoagulable state presented with acute unremitting flank pain, nausea and vomiting. We report a case of a 35-year-old man with underlying nephrotic syndrome who presented with three days history of acute non-localized and non-resolving abdominal pain and vomiting. He was initially referred to general surgery for acute intestinal obstruction. Contrast-enhanced computed tomography (CECT) abdomen revealed acute left renal infarction secondary to total thrombotic occlusion of the left renal artery. The patient was treated with endovascular manual aspiration thrombectomy resulting in partial revascularization of left renal artery with restoration of renal function, complete resolution of symptom and good clinical outcomes. This case report serves as a reminder for physicians to include renal infarction in the differential diagnosis when evaluating a patient with acute abdomen, particularly in patient with hypercoagulable state. This case also aligns with other experiences demonstrating positive outcomes after endovascular thrombectomy, even in the presence of prolonged renal ischemia time of more than 72 hours.

Acute Renal Infarction. A Case Report

Renal infarction is a rare disease often overlooked due to its very unspecific clinical presentation. We report the particular case of an idiopathic bilateral acute renal infarction occurring in a young adult male. The diagnostic delay in our patient is significant: ten days. However, a Doppler ultrasound allows screening. The diagnosis of certainty is made by the angioCT scan: essential examination to make the lesional balance sheet and to evaluate the prognosis on the renal function. Anticoagulant treatment is the treatment of choice provided it is instituted early.

Acute Renal Infarction Due to Symptomatic Isolated Spontaneous Renal Artery Dissection: A Rare and Fatal Disease.

To report demographics and clinical, laboratory, and imaging features of acute renal infarction (ARI) due to symptomatic isolated spontaneous renal artery dissection (SISRAD) and to analyze outcomes after the initial therapy for SISRAD. Thirteen patients with ARI due to SISRAD between January 2016 and March 2021 were enrolled in this retrospective study. We reviewed the demographics, clinical, laboratory, and imaging features (location of the infarct kidney, the branch artery involved by dissection, true lumen stenosis, false lumen thrombosis, and aneurysm), treatment modalities, and follow-up results; analyzed the difference between SISRAD and other causes of ARI; and propose an appropriate therapy strategy for SISRAD based on our data and literature. Patients with ARI due to SISRAD were mostly young men (43 [24-53] years; 12/13 [92%]). No patients had atrial fibrillation or acute kidney injury at admission (0/13). All 13 patients received conservative treatment as the initial treatment. Sixty-two percent (8/13) of patients progressed, and 88% (7/8) of them had dissection aneurysm on the admission computed tomographic angiography (CTA) image. Seventy-five percent (6/8) of patients underwent endovascular intervention as follows, stent placement in 1 patient, renal artery embolization in 1, and stent placement with embolization in 4. Two patients with disease progression died: 1 during the conservative treatment period and 1 after the stent placement. Thirty-eight percent (5/13) of patients in remission continued to receive conservative treatment, none of whom had dissection aneurysm on the admission CTA. Symptomatic isolated spontaneous renal artery dissection is a rare and fatal disease. For young ARI patients with no previous history of tumors and cardiogenic diseases, CTA examination is recommended to exclude SISRAD. Dissection aneurysm seems to be a risk of progression for SISRAD in this series. Conservative treatment, a recognized initial treatment, has a good effect on patients without dissection aneurysm, and we recommend endovascular intervention as the initial treatment for the patient with dissection aneurysm at admission. Multicenter clinical studies are needed to explore a more-appropriate treatment for patients with SISRAD. This article report the related factors, risks, demographics and laboratory data of Acute renal infarction (ARI) due to Symptomatic isolated spontaneous renal artery dissection (SISRAD) and explore a better initial therapy strategy for SISRAD. It will help improve the effectiveness of SISRAD treatment and reduce the mortality rate from this rare but lethal disease.

216 - Acute renal infarction presenting as hypertensive urgency

216 - Acute renal infarction presenting as hypertensive urgency

Renal Infarction: Clinical and Evolutionary Aspects in the Nephrology Department Ibn Sina University Hospital of Rabat-Morocco

Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.

Acute Renal Infarction and Cholesterol Crystal Embolism Due to Plaque Rupture in a Renal Artery.

Acute Renal Infarction and Cholesterol Crystal Embolism Due to Plaque Rupture in a Renal Artery.

A rare cause of abdominal pain managed unconventionally: acute renal infarction caused by atrial fibrillation: a case report

BackgroundAtrial 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 reportsWe 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.ConclusionsAcute 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.

Acute Renal Infarction: A Single-Center Experience

Objective: The aim of this study is to evaluate the clinical characteristics and short- and midterm renal functions in patients with acute renal infarction. Methods: The medical records of the patients who were diagnosed with acute renal infarction by computed tomography in our clinic between 2012 and 2019 were retrospectively reviewed. Twenty-four patients who had follow-up data for at least 1 year were included in the study. Clinical, radiological, and laboratory findings of the patients at the time of admission and the results of serum creatinine level and glomerular filtration rate at first month and first year were recorded. Results: The mean age of the patients was 49.5 ± 20.7 years. In half of the cases, cardiac origin diseases were the underlying risk factor of acute renal infarction. Flank/abdominal pain was the most common presenting symptom. At admission, mean white blood cell count, serum lactate dehydrogenase, serum creatinine, and glomerular filtration rate values were 12 507 ± 6367/μL, 437.4 ± 261 U/L, 1.4 ± 1.9 mg/dL, and 85.3 ± 47.7 mL/min/1.73 m2, respectively. Chronic kidney disease developed in 7 patients. Conclusions: Acute renal infarction should be taken into consideration in patients with flank or abdominal pain and increased serum lactate dehydrogenase level. In addition, patients with acute renal infarction are at risk of developing chronic kidney disease.

Acil Bölümünde Nadir Bir Tanı: Renal Enfarktüs

Objective: Renal infarction (RI), which is caused by sudden cessation of renal blood flow, is a rare disease. In this study, we planned to investigate the demographic and clinical characteristics and outcomes of patients diagnosed with renal infarction in the emergency department.
 Material and Methods: Patients over the age of 18 who presented to the emergency department with abdominal/flank pain, nausea, and vomiting between 2010 and 2021 and were diagnosed with acute renal infarction in contrast-enhanced abdominal computed tomography were included in the study. The data of the patients were reviewed retrospectively. Demographic and clinical characteristics, as well as laboratory results of the patients, were recorded. 
 Results: A total of 38 patients were included in the study. The mean age of the patients was 61.8±18 years and 63.2% (n=24) were male. The most common complaints of the patients were abdominal pain (84.2%), flank pain (68.4%), and nausea-vomiting (50%). More rarely, patients complained about chest pain, dyspnea, and fever. Acute renal failure developed in 4 patients (10.5%). While only three (7.9%) of the patients had no known disease, the others had comorbidities such as hypertension (31.6%), ischemic heart disease (31.6%), previous thromboembolic events (31.6%), diabetes (26.3%), cancer (23.7%), heart failure (21.1%), and atrial fibrillation (18.4%). The most common cause of RI was cardioembolic events (44.7%), followed by hypercoagulability (28.9%), renal artery damage (15.8%), and idiopathic causes (10.5%).
 Conclusion: Acute RI is a disease that is rarely detected in the emergency department. Because there is a lack of specific clinical findings, it is often overlooked or diagnosed late. Delay in diagnosis can significantly cause morbidity and mortality. The diagnosis of acute RI should be considered especially in patients with a high risk of thromboembolism and who present to the emergency department with complaints of unexplained abdominal or flank pain.

Acute Renal Infarction and Graft Loss Secondary to Acute Atrial Fibrillation in a Kidney Transplant Patient: A Case Report

Acute Renal Infarction and Graft Loss Secondary to Acute Atrial Fibrillation in a Kidney Transplant Patient: A Case Report

Cardioembolic-related renal infarction

Acute renal infarction is a rare condition that can progress to renovascular hypertension, chronic kidney disease, and end-stage kidney disease, depending on the severity. We present a case of a 30-year-old man with no significant past medical history who presented with sudden onset right flank pain. Initially pyelonephritis was suspected but it was later found to be acute renal infarction secondary to cardioemboli from atrial fibrillation.

794 Use of Cultured Epithelial Autografts After Biodegradable Temporizing Matrix in Massive Burns

IntroductionAs burn care advances, patients are surviving with larger burn injuries, that previously would have been fatal. However, the need for autologous skin coverage continues to be an unmet need for massive burn injuries. Several attempts have been made to address this with various dermal substitutes, temporary coverage, and skin substitutes. For 25 years, Cultured Epithelial Autografts (CEA) have been used to treat large burn injuries, but this was met with variable success and has a mandatory pre-requisite lab time before it is ready for use. In 2018, Biodegradable Temporizing Matrix (BTM) that can be placed immediately on excised burns was first studied in burn patients, which has led to its increased use in subsequent years. This case series seeks to examine our experience using CEA following the application and ingrafting of BTM on large burns.MethodsA retrospective review was conducted from 2017-2020 of adult burn patients admitted to an ABA verified burn center who underwent placement of both BTM and CEA. Demographics, mechanism of injury, burn characteristics, surgeries, and outcome data were collected. Surgical technique was early excision, BTM placement, a BTM integration period, repeat superficial excision, fibrin/thrombin spray, split thickness skin grafting with usually 6:1 mesh autograft, and finally CEA application. CEA was managed per manufacturer protocols. Descriptive statistics and univariate analyses were performed with Microsoft Excel.ResultsEight patients met inclusion criteria. The average age was 29.3±5.3 years, 2nd degree TBSA 22.5±22.6%, 3rd degree TBSA 55.8±21%, and total TBSA was 78.3±4.4%. Four patients died during their hospital course and four survived to discharge. For survivors, the age length of stay was 135±23.6 days and they underwent an average of 8.5±1.5 total excision and/or grafting procedures. All patients had severe complications including severe sepsis/septic shock (n=8), gastrointestinal bleeds (n=2), acute respiratory distress syndrome (n=3), acute kidney injury or renal failure (n=4), pulmonary embolism (n=1) and myocardial infarction (n=1). The average time to 95% wound closure was 5 (79-147) days for survivors.ConclusionsThere continues to be an unmet need for autologous skin coverage in massive burn injuries when there is insufficient donor skin. In this series, we describe eight patients with massive burn injuries who underwent initial BTM placement, followed by 6:1 meshed autograft and CEA application. Although four patients died during their treatment course, the four surviving patients had acceptable wound closure rates and length of stay for their burn size.

371 Fibromuscular Dysplasia Presenting as Acute Unilateral Renal Infarction in a Normotensive Patient

371 Fibromuscular Dysplasia Presenting as Acute Unilateral Renal Infarction in a Normotensive Patient

Minimal access compared to sternotomy for aortic root and arch surgery

Introduction Partial upper sternotomy is an established technique for aortic valve surgery in numerous centers. Based on the favorable results, this access can be extended for more complex procedures. We assessed the outcomes of aortic root and arch surgery through partial versus full sternotomy. Patients and methods From January 2013 to December 2020, 100 patients underwent proximal aortic surgery. The minimal access approach was used in 73 patients. Operative variables and outcomes were retrospectively analyzed and compared between both groups. Results There was no significant difference in cross-clamping and extracorporeal circulation times, as well as no difference in postoperative acute renal failure, stroke, myocardial infarction, and re-exploration for bleeding. However, there was a significant difference in favor of partial upper sternotomy in red blood cell transfusion (0 vs. 234 mL; p = 0.01), postoperative drainage volume (300 vs. 750 mL; p < 0.001), ventilation time (median 3 vs. 24 h; p < 0.001), sepsis (1 [1.4%] vs. 4 [14.8%]; p = 0.02), intensive care unit (median 2 vs. 4 days; p = 0.002) and hospital stay (median 7 vs. 10 days; p < 0.001). Only one patient required intraoperative conversion due to massive bleeding. There was no difference in 30-day mortality between both groups. Conclusion The partial upper sternotomy approach is safe and feasible for aortic root and arch surgery with morbidity and mortality rates similar to full sternotomy, with the advantages of less blood loss and transfusions need, faster extubation, and shorter length of hospital stay.

Early Diagnosis and Intervention of Acute Renal Infarction with Catheter-Directed Thrombolytic Therapy.

Acute renal infarction is a rare and under-diagnosed disease for which the optimal treatment is unknown. This study aimed to determine the utility of catheter-directed thrombolysis (CDT) to treat acute renal infarction. 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. 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. 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.

Paradigm shift in MIS-C – the case of a perfect storm

Acute renal infarction in pediatric patients is a rare oc­cur­rence, usually associated with cardiac anomalies, hyper­coagulable state, diseases with local thrombotic potential, systemic infections, or autoimmune diseases. Following the COVID-19 pandemic, the medical scientific community established diagnostic criteria for PIMS-TS (Pediatric In­flam­matory Multisystem Syndrome – temporally as­so­cia­ted with SARS-CoV-2), also known as multisystem inflamma­to­ry syndrome in children (MIS-C), a condition found in chil­­dren exposed to the new type of coronavirus. Three cli­­ni­­cal phenotypes have been established: toxic shock syn­­drome, Kawasaki-like disease, and undefined in­flam­ma­tory presentation. Cardiovascular manifestations were con­si­dered prominent in all clinical scenarios, while renal and neurologic involvement played a secondary role. There is, however, mounting evidence suggesting that MIS-C is in fact a miscellaneous pathology and that a focus change is war­ranted.