II. Epidemiology

  1. Rare event

III. Pathophysiology

  1. Arterial thromboembolic event resulting in Occlusion of the renal artery or its segmental branches

IV. Risk Factors: Arterial Embolism Risk

  1. Case study based associations
    1. Atrial Fibrillation (65%)
    2. Hypertension (53%)
    3. Ischemic Heart Disease (41%)
    4. Prior Thromboembolic Events (35%)
    5. Mitral Stenosis (35%)
    6. Domanovitis (1999) Medicine 78(6): 386-94 [PubMed]
  2. Other Risk Factors
    1. Tobacco Abuse
    2. Hypercoagulable State
    3. Connective Tissue Disorders
    4. Vasculitis
    5. Atherosclerotic vascular disease involving the aorta or renal arteries
    6. Angiography (dislodged atherosclerotic Plaque)
    7. Endocarditis
    8. Abdominal Aortic Aneurysm
    9. Abdominal or flank Trauma

V. Symptoms

VI. Differential Diagnosis

  1. See Flank Pain
  2. See Hematuria Causes
  3. Ureteral Stone
    1. Renal Infarct diagnosis is frequently delayed due to misdiagnosis as Ureteral Stone
    2. Perform CT imaging with IV contrast to evaluated for broader differential in higher risk patients (see below)

VII. Labs

  1. Comprehensive Metabolic Panel
    1. Increased Serum Creatinine may be present
  2. Lactate Dehydrogenase (LDH)
    1. May be increased
  3. Urinalysis
    1. Gross or Microscopic Hematuria
    2. Proteinuria may be present

VIII. Imaging

  1. CT Abdomen and Pelvis with IV Contrast
    1. With IV contrast, infarcted renal Medulla will fail to enhance compared with the surrounding cortex
      1. Infarcts are best seen when imaged at 25 to 70 seconds after contrast (typical CT portal venous phase)
    2. Flank Pain is often imaged without contrast (for Ureterolithiasis), which will typically miss Renal Infarcts
      1. Use IV contrast for CT, when broader differential is pursued (esp. in patients at risk for Thromboembolism)
      2. IV contrast does not diminish CT Test Sensitivity for Clinically SignificantUreteral Stones
      3. Dym (2014) Abdom Imaging 39(3): 526-32 [PubMed]

IX. References

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