Renal infarction

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

• Nephrolithiasis
• Pyelonephritis
• Mesenteric ischemia
• Lower lobe pneumonia

Evaluation

Laboratory

• CBC with differential/CMP, LDH, urinalysis, urine culture

• EKG- to evaluate for arrhythmia

Imaging:

• CT w/ IV contrast (preferred study)
• Ultrasound - less senstive
• MRI with gadolinium (contraindicated with severe renal impairment due to risk of nephrogenic systemic fibrosis)
• Radioisotope scan - not commonly used

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.