Renal infarction: Difference between revisions
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==Background== | ==Background== | ||
*Low ED incidence, approximately 1 per 90 to 100, 000 visits a year | *Low ED incidence, approximately 1 per 90 to 100, 000 visits a year | ||
*Diagnosis frequently missed due to mimicking symptoms similar to other more frequent complaints such as [[pyelonephritis]] and [[nephrolithiasis]] | |||
*Caused by interruption of blood supply to kidney | *Caused by interruption of blood supply to kidney | ||
===Major causes=== | ===Major causes=== | ||
*Cardioembolic disease | *Cardioembolic disease | ||
*Renal artery injury | *Renal artery injury | ||
*Hypercoagulable state | *[[Hypercoagulable state]] | ||
*Dissection | *[[Dissection]] | ||
*Vasculitis | *[[Vasculitis]] | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Flank pain]] | |||
*[[Nausea]], [[vomiting]] | |||
*Sudden onset | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Flank pain DDX}} | |||
==Evaluation== | ==Evaluation== | ||
===Laboratory=== | |||
*CBC with differential, CMP, LDH, urinalysis, urine culture | |||
* [[EKG]]- to evaluate for arrhythmia | |||
===Imaging<ref>Decoste R, Himmelman JG, Grantmyre J. Acute renal infarct without apparent cause: A case report and review of the literature. Canadian Urological Association Journal. 2015;9(3-4):E237-E239. doi:10.5489/cuaj.2466.</ref>=== | |||
*CT with IV contrast (preferred study) | |||
*[[Renal ultrasound]] - less senstive | |||
*MRI with gadolinium (contraindicated with severe renal impairment due to risk of nephrogenic systemic fibrosis) | |||
*Radioisotope scan - not commonly used | |||
==Management== | ==Management== | ||
*No clinical guidelines available, but mainstays of therapies include anticoagulation and endovascular therapy | |||
*Endovascular therapy (thrombolysis/thrombectomy/angioplasty) | |||
**Indicated if acute occlusion involving main renal artery or segmental branches | |||
**Greatest likelihood of benefit if performed early | |||
*Anticoagulation: | |||
**IV [[Heparin]] followed by oral [[Coumadin]] | |||
**Indicated in patients with renal infarction in the setting of Atrial fibrillation, LV thrombus, and hyper coagulable state | |||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
Latest revision as of 00:38, 27 January 2019
Background
- Low ED incidence, approximately 1 per 90 to 100, 000 visits a year
- Diagnosis frequently missed due to mimicking symptoms similar to other more frequent complaints such as pyelonephritis and nephrolithiasis
- Caused by interruption of blood supply to kidney
Major causes
- Cardioembolic disease
- Renal artery injury
- Hypercoagulable state
- Dissection
- Vasculitis
Clinical Features
- Flank pain
- Nausea, vomiting
- Sudden onset
Differential Diagnosis
Flank Pain
- Vascular
- Abdominal aortic aneurysm
- Renal artery embolism
- Renal vein thrombosis
- Aortic dissection
- Mesenteric ischemia
- Renal
- Pyelonephritis
- Perinephric abscess
- Perinephric hematoma
- Papillary necrosis
- Renal cell carcinoma
- Obstructive uropathy
- May or may not be due to nephrolithiasis
- Renal infarction
- Renal hemorrhage
- Ureter
- Nephrolithiasis
- Blood clot
- Stricture
- Tumor (primary or metastatic)
- Bladder
- Tumor
- Varicose vein
- Cystitis
- GI
- Biliary colic
- Pancreatitis
- Perforated peptic ulcer
- Appendicitis (appendix may be pushed to RUQ in pregnancy)
- Inguinal Hernia
- Diverticulitis
- Cancer
- Bowel obstruction
- Gynecologic
- Ectopic Pregnancy
- PID/TOA
- Ovarian cyst
- Ovarian torsion
- Endometriosis
- Mittelschmerz or benign ovulatory pain
- GU
- Other
- Shingles
- Lower lobe pneumonia
- Retroperitoneal hematoma, abscess, or tumor
- Epidural abscess
- Epidural hematoma
- Rib contusion/fracture
Evaluation
Laboratory
- CBC with differential, CMP, LDH, urinalysis, urine culture
- EKG- to evaluate for arrhythmia
Imaging[1]
- CT with IV contrast (preferred study)
- Renal ultrasound - less senstive
- MRI with gadolinium (contraindicated with severe renal impairment due to risk of nephrogenic systemic fibrosis)
- Radioisotope scan - not commonly used
Management
- No clinical guidelines available, but mainstays of therapies include anticoagulation and endovascular therapy
- Endovascular therapy (thrombolysis/thrombectomy/angioplasty)
- Indicated if acute occlusion involving main renal artery or segmental branches
- Greatest likelihood of benefit if performed early
- Anticoagulation:
Disposition
- Admit
See Also
References
- ↑ Decoste R, Himmelman JG, Grantmyre J. Acute renal infarct without apparent cause: A case report and review of the literature. Canadian Urological Association Journal. 2015;9(3-4):E237-E239. doi:10.5489/cuaj.2466.