Renal infarction in the ED: 10-year experience and review of the literature

Meir Antopolsky, Natalia Simanovsky, Ruth Stalnikowicz, Shaden Salameh, Nurith Hiller
American Journal of Emergency Medicine 2012, 30 (7): 1055-60

OBJECTIVE: We aimed to describe clinical and radiologic features of acute renal infarction (RI).

METHODS: Clinical, computed tomography (CT), and laboratory findings were retrospectively reviewed for patients diagnosed from 1999 to 2009 with CT proof of acute RI. Possible etiology of infarction was recorded. All available published series of RI were reviewed.

RESULTS: Thirty-eight patients with acute RI met inclusion criteria; 127 cases of RI from 7 previous series were pooled for analysis. The most common symptoms were abdominal pain, flank pain, nausea, and vomiting. Leukocytosis (>10 × 10(9)/L) and elevated lactate dehydrogenase levels (>620 IU/L) were the most prominent laboratory findings. Computed tomography features included wedge-shaped hypodensities in the renal parenchyma in 35 (92%) and global renal ischemia in 3 (8%) patients; 13 patients (34%) had concomitant splenic infarction. The most common etiology was atrial fibrillation. Computed tomography determined the specific cause for RI in 5 patients (13%) and a possible etiology in 17 (45%). Exact correlation with previous series was limited by methodological diversity.

CONCLUSION: Renal infarction should be considered in the differential diagnosis of a patient presented to the emergency department with abdominal or flank pain. Laboratory workup should include lactate dehydrogenase levels. After ruling out stone disease, contrast-enhanced CT examination is essential for the diagnosis.

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