Renal infarction

Last updated
Renal infarction
Other namesKidney infarction
Niereninfarkt in der Computertomographie.jpg
CT scan of the abdomen showing partial infarct of the left kidney.
Specialty Nephrology
Symptoms Abdominal pain, nausea, vomiting, and fever. [1]
Complications Acute kidney injury and chronic kidney disease. [1]
CausesCardioembolic disease, renal artery injury, and hypercoagulable state. [1]
Diagnostic method Hematuria, elevated lactate dehydrogenase, CT scan. [1]
Differential diagnosis Renal colic and acute pyelonephritis. [1]
Frequency1.4% (of 14,411) [2]

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. [3] Patients who have experienced an acute renal infarction usually report sudden onset flank pain, which is often accompanied by fever, nausea, and vomiting. [4]

Contents

The primary causes of renal infarction are hypercoagulable conditions, renal artery damage (usually brought on by arterial dissection), and cardioembolic illness. [5]

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. [4]

Complications

Complications include acute kidney injury that can progress to chronic kidney disease. [6]

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. [4]

Risk factors

Atrial fibrillation, a prior embolism history, mitral stenosis, diabetes, hypertension, and ischemic heart disease are risk factors for renal infarction. [7]

Diagnosis

Most patients have been reported to have gross or microscopic hematuria. [8] Significantly increased serum lactate dehydrogenase levels and proteinuria may also be observed. [7] 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. [4]

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. [4]

Outlook

Renal infarction 30-day mortality was 11.4% in a retrospective analysis of 44 individuals with atrial fibrillation and renal infarction. [8]

Epidemiology

In 1940, a study of 14,411 autopsies revealed that 1.4% of the cases involved renal infarction. [2]

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%. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Angioplasty</span> Procedure to widen narrow arteries or veins

Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis.

<span class="mw-page-title-main">Coronary artery bypass surgery</span> Surgical procedure to restore normal blood flow to an obstructed coronary artery

Coronary artery bypass surgery, also known as coronary artery bypass graft, is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pain caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass narrowings in heart arteries by using arteries or veins harvested from other parts of the body, thus restoring adequate blood supply to the previously ischemic heart.

<span class="mw-page-title-main">Interventional radiology</span> Medical subspecialty

Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.

<span class="mw-page-title-main">Renal artery stenosis</span> Medical condition

Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney, resulting in renovascular hypertension – a secondary type of high blood pressure. Possible complications of renal artery stenosis are chronic kidney disease and coronary artery disease.

Mixed connective tissue disease (MCTD) is a systemic autoimmune disease that shares characteristics with at least two other systemic autoimmune diseases, including systemic sclerosis (Ssc), systemic lupus erythematosus (SLE), polymyositis/dermatomyositis (PM/DM), and rheumatoid arthritis. The idea behind the "mixed" disease is that this specific autoantibody is also present in other autoimmune diseases such as systemic lupus erythematosus, polymyositis, scleroderma, etc. MCTD was characterized as an individual disease in 1972 by Sharp et al., and the term was introduced by Leroy in 1980.

Abdominal angina is abdominal pain after eating that occurs in individuals with ongoing poor blood supply to their small intestines known as chronic mesenteric ischemia. Although the term angina alone usually denotes angina pectoris, angina by itself can also mean "any spasmodic, choking, or suffocative pain", with an anatomic adjective defining its focus; so, in this case, spasmodic pain in the abdomen. Stedman's Medical Dictionary Online defines abdominal angina as "intermittent abdominal pain, frequently occurring at a fixed time after eating, caused by inadequacy of the mesenteric circulation resulting from arteriosclerosis or other arterial disease. Synonym: intestinal angina."

<span class="mw-page-title-main">Computed tomography angiography</span> Medical investigation technique

Computed tomography angiography is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, images are created to look for blockages, aneurysms, dissections, and stenosis. CTA can be used to visualize the vessels of the heart, the aorta and other large blood vessels, the lungs, the kidneys, the head and neck, and the arms and legs. CTA can also be used to localise arterial or venous bleed of the gastrointestinal system.

<span class="mw-page-title-main">Anterior cerebral artery syndrome</span> Medical condition

Anterior cerebral artery syndrome is a condition whereby the blood supply from the anterior cerebral artery (ACA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the medial aspects of the frontal and parietal lobes, basal ganglia, anterior fornix and anterior corpus callosum.

<span class="mw-page-title-main">Systemic vasculitis</span> Medical condition

Necrotizing vasculitis, also called systemic necrotizing vasculitis, is a general term for the inflammation of veins and arteries that develops into necrosis and narrows the vessels.

Pincer nails are a toenail disorder in which the lateral edges of the nail slowly approach one another, compressing the nailbed and underlying dermis. It occurs less often in the fingernails than toenails, and there usually are no symptoms.

<span class="mw-page-title-main">Light chain deposition disease</span> Medical condition

Light chain deposition disease (LCDD) is a rare blood cell disease which is characterized by deposition of fragments of infection-fighting immunoglobulins, called light chains (LCs), in the body. LCs are normally cleared by the kidneys, but in LCDD, these light chain deposits damage organs and cause disease. The kidneys are almost always affected and this often leads to kidney failure. About half of people with light chain deposition disease also have a plasma cell dyscrasia, a spectrum of diseases that includes multiple myeloma, Waldenström's macroglobulinemia, and the monoclonal gammopathy of undetermined significance premalignant stages of these two diseases. Unlike in AL amyloidosis, in which light chains are laid down in characteristic amyloid deposits, in LCDD, light chains are deposited in non-amyloid granules.

<span class="mw-page-title-main">Pulmonary capillary hemangiomatosis</span> Medical condition

Pulmonary capillary hemangiomatosis (PCH) is a disease affecting the blood vessels of the lungs, where abnormal capillary proliferation and venous fibrous intimal thickening result in progressive increase in vascular resistance. It is a rare cause of pulmonary hypertension, and occurs predominantly in young adults. Together with pulmonary veno-occlusive disease, PCH comprises WHO Group I' causes for pulmonary hypertension. Indeed, there is some evidence to suggest that PCH and pulmonary veno-occlusive disease are different forms of a similar disease process.

Blood pool agents (BPAs) are a class of magnetic resonance angiography contrast agents. Blood pool agents are differentiated from other contrast agents due to their high molecular weight and higher relaxivities. Their large size prevents diffusion through the vascular epithelium and leakage into the interstitial space, and because of this they stay in the vascular system for a longer time period. Most contrast agents, leave the vascular system within a few minutes, however blood pool agents remain in the circulation for up to an hour, extending the window available for imaging. Longer image acquisition times allow better signal-to-noise ratio and improved image resolution.

<span class="mw-page-title-main">Transplant glomerulopathy</span> Medical condition

Transplant glomerulopathy(TG) is a morphologic lesion of renal allografts that is histologically identified by glomerular basement membrane (GBM) duplication and/or multilayering. Proteinuria, hypertension, and deteriorating graft function are the hallmarks of TG.

<span class="mw-page-title-main">Eosinophilic cystitis</span> Medical condition

Eosinophilic cystitis is a rare type of interstitial cystitis first reported in 1960 by Edwin Brown. Eosinophilic cystitis has been linked to a number of etiological factors, including allergies, bladder tumors, trauma to the bladder, parasitic infections, and chemotherapy drugs, though the exact cause of the condition is still unknown. The antigen-antibody response is most likely the cause of eosinophilic cystitis. This results in the generation of different immunoglobulins, which activate eosinophils and start the inflammatory process.

<span class="mw-page-title-main">Pulmonary vein stenosis</span> Medical condition

Pulmonary vein stenosis is a rare cardiovascular disorder. It is recognized as being the stenosis of one or more of the four pulmonary veins that return blood from the lungs to the left atrium of the heart. In congenital cases, it is associated with poor prognosis and high mortality rate. In some people, pulmonary vein stenosis occurs after pulmonary vein ablation for the treatment of atrial fibrillation. Some recent research has indicated that it may be genetically linked in congenital cases.

<span class="mw-page-title-main">Lupus vasculitis</span> Medical condition

Lupus vasculitis is one of the secondary vasculitides that occurs in approximately 50% of patients with systemic lupus erythematosus (SLE).

Kidney ischemia is a disease with a high morbidity and mortality rate. Blood vessels shrink and undergo apoptosis which results in poor blood flow in the kidneys. More complications happen when failure of the kidney functions result in toxicity in various parts of the body which may cause septic shock, hypovolemia, and a need for surgery. What causes kidney ischemia is not entirely known, but several pathophysiology relating to this disease have been elucidated. Possible causes of kidney ischemia include the activation of IL-17C and hypoxia due to surgery or transplant. Several signs and symptoms include injury to the microvascular endothelium, apoptosis of kidney cells due to overstress in the endoplasmic reticulum, dysfunctions of the mitochondria, autophagy, inflammation of the kidneys, and maladaptive repair.

Gaetano Ciancio is an Italian American surgeon at the University of Miami who specializes in kidney transplant. He is the chief medical and academic officer of the Miami Transplant Institute and the director of its Kidney & Kidney-Pancreas Programs. His most significant contributions to medicine are related to surgically treating kidney cancer once it has spread to the inferior vena cava and in optimizing the immunosuppression protocol after kidney transplant.

References

  1. 1 2 3 4 5 Saju, Jiya Mulayamkuzhiyil; Leslie, Stephen W. (2023-05-30). "Renal Infarction". StatPearls Publishing. PMID   35881744 . Retrieved 2024-02-23.
  2. 1 2 Hoxie, Harold J. (1940-03-01). "RENAL INFARCTION: STATISTICAL STUDY OF TWO HUNDRED AND FIVE CASES AND DETAILED REPORT OF AN UNUSUAL CASE". Archives of Internal Medicine. 65 (3): 587. doi:10.1001/archinte.1940.00190090124007. ISSN   0730-188X.
  3. Faucon, Anne-Laure; Bobrie, Guillaume; Jannot, Anne-Sophie; Azarine, Arshid; Plouin, Pierre-François; Azizi, Michel; Amar, Laurence (2018). "Cause of renal infarction" (PDF). Journal of Hypertension. 36 (3). Ovid Technologies (Wolters Kluwer Health): 634–640. doi:10.1097/hjh.0000000000001588. ISSN   0263-6352. PMID   29045340. S2CID   40348543.
  4. 1 2 3 4 5 Saeed, Khawer (2012). "Renal infarction". International Journal of Nephrology and Renovascular Disease. 5. Informa UK Limited: 119–123. doi: 10.2147/ijnrd.s33768 . ISSN   1178-7058. PMC   3437809 . PMID   22969301.
  5. Oh, Yun Kuy; Yang, Chul Woo; Kim, Yong-Lim; Kang, Shin-Wook; Park, Cheol Whee; Kim, Yon Su; Lee, Eun Young; Han, Byoung Geun; Lee, Sang Ho; Kim, Su-Hyun; Lee, Hajeong; Lim, Chun Soo (2016). "Clinical Characteristics and Outcomes of Renal Infarction". American Journal of Kidney Diseases. 67 (2). Elsevier BV: 243–250. doi:10.1053/j.ajkd.2015.09.019. ISSN   0272-6386. PMID   26545635.
  6. Kwon, Jae Hyun; Oh, Bum Jin; Ha, Sang Ook; Kim, Dae Yong; Do, Han Ho (2016). "Renal Complications in Patients with Renal Infarction: Prevalence and Risk Factors". Kidney and Blood Pressure Research. 41 (6). S. Karger AG: 865–872. doi: 10.1159/000452589 . ISSN   1420-4096. PMID   27871081.
  7. 1 2 3 Domanovits, Hans; Paulis, Monika; Nikfardjam, Mariam; Meron, Giora; Kürkciyan, Istepan; Bankier, Alexander A.; Laggner, Anton N. (1999). "Acute Renal Infarction: Clinical Characteristics of 17 Patients". Medicine. 78 (6). Ovid Technologies (Wolters Kluwer Health): 386–394. doi:10.1097/00005792-199911000-00004. ISSN   0025-7974. PMID   10575421.
  8. 1 2 Hazanov, Natasha; Somin, Marina; Attali, Malka; Beilinson, Nick; Thaler, Michael; Mouallem, Meir; Maor, Yasmin; Zaks, Nurit; Malnick, Stephen (2004). "Acute Renal Embolism". Medicine. 83 (5). Ovid Technologies (Wolters Kluwer Health): 292–299. doi:10.1097/01.md.0000141097.08000.99. ISSN   0025-7974. PMID   15342973.

Further reading