- Jai Radhakrishnan, MD, MS
Jai Radhakrishnan, MD, MS
- Professor of Medicine
- Columbia University Medical Center
Renal infarction is rare [1-7]. In a study of 14,411 autopsies published in 1940, the incidence of renal infarction was 1.4 percent . In a later series of almost 250,000 patients seen at an emergency department over four years, only 17 (0.007 percent) were diagnosed with acute renal infarction .
The frequency of renal infarction is probably higher than reported in the above studies since clinical diagnosis of renal infarction is frequently missed or delayed because the patients present with abdominal or flank pain that mimic other, more common conditions, such as nephrolithiasis and pyelonephritis. (See 'Clinical presentation' below.)
The two major causes of renal infarction are thromboemboli, which usually originate from a thrombus in the heart or aorta, and in-situ thrombosis, which may cause complete occlusion of the main renal artery or a segmental branch artery [1,7]. The renal manifestations are different with atheroemboli, which, because they are typically nondistensible, irregularly shaped, and smaller in size, tend to produce incomplete arterial occlusion of more distal vessels, with secondary ischemic atrophy rather than renal infarction. (See "Clinical presentation, evaluation, and treatment of renal atheroemboli", section on 'Kidney injury'.)
Thromboembolic renal infarction is reviewed here. The major sources of embolism from the heart, thromboembolism from aortic plaque, and the manifestations of atheroembolic disease are discussed separately. (See "Echocardiography in detection of cardiac and aortic sources of systemic embolism" and "Embolism from aortic plaque: Thromboembolism" and "Embolism from atherosclerotic plaque: Atheroembolism (cholesterol crystal embolism)".)
ETIOLOGY AND PATHOGENESIS
The major causes of renal infarction include cardioembolic disease, renal artery injury, and hypercoagulable states [1,3,5,8,9]:
- Bourgault M, Grimbert P, Verret C, et al. Acute renal infarction: a case series. Clin J Am Soc Nephrol 2013; 8:392.
- Domanovits H, Paulis M, Nikfardjam M, et al. Acute renal infarction. Clinical characteristics of 17 patients. Medicine (Baltimore) 1999; 78:386.
- Hazanov N, Somin M, Attali M, et al. Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation. Medicine (Baltimore) 2004; 83:292.
- Chu PL, Wei YF, Huang JW, et al. Clinical characteristics of patients with segmental renal infarction. Nephrology (Carlton) 2006; 11:336.
- Antopolsky M, Simanovsky N, Stalnikowicz R, et al. Renal infarction in the ED: 10-year experience and review of the literature. Am J Emerg Med 2012; 30:1055.
- Hoxie HJ, Coggin CB. Renal Infarction: Statistical study of two hundred and five cases and detailed report of an unusual case. Arch Intern Med 1940; 65:587.
- Paris B, Bobrie G, Rossignol P, et al. Blood pressure and renal outcomes in patients with kidney infarction and hypertension. J Hypertens 2006; 24:1649.
- Caravaca-Fontán F, Pampa Saico S, Elías Triviño S, et al. Acute renal infarction: Clinical characteristics and prognostic factors. Nefrologia 2015.
- Oh YK, Yang CW, Kim YL, et al. Clinical Characteristics and Outcomes of Renal Infarction. Am J Kidney Dis 2016; 67:243.
- Frost L, Engholm G, Johnsen S, et al. Incident thromboembolism in the aorta and the renal, mesenteric, pelvic, and extremity arteries after discharge from the hospital with a diagnosis of atrial fibrillation. Arch Intern Med 2001; 161:272.
- Filippone EJ, Foy A, Galanis T, et al. Segmental arterial mediolysis: report of 2 cases and review of the literature. Am J Kidney Dis 2011; 58:981.
- Cosby RL, Miller PD, Schrier RW. Traumatic renal artery thrombosis. Am J Med 1986; 81:890.
- Krämer SC, Seifarth H, Pamler R, et al. Renal infarction following endovascular aortic aneurysm repair: incidence and clinical consequences. J Endovasc Ther 2002; 9:98.
- Ivanovic V, McKusick MA, Johnson CM 3rd, et al. Renal artery stent placement: complications at a single tertiary care center. J Vasc Interv Radiol 2003; 14:217.
- Böckler D, Krauss M, Mansmann U, et al. Incidence of renal infarctions after endovascular AAA repair: relationship to infrarenal versus suprarenal fixation. J Endovasc Ther 2003; 10:1054.
- Stawicki SP, Rosenfeld JC, Weger N, et al. Spontaneous renal artery dissection: three cases and clinical algorithms. J Hum Hypertens 2006; 20:710.
- Bemanian S, Motallebi M, Nosrati SM. Cocaine-induced renal infarction: report of a case and review of the literature. BMC Nephrol 2005; 6:10.
- Bolderman R, Oyen R, Verrijcken A, et al. Idiopathic renal infarction. Am J Med 2006; 119:356.e9.
- Lumerman JH, Hom D, Eiley D, Smith AD. Heightened suspicion and rapid evaluation with CT for early diagnosis of partial renal infarction. J Endourol 1999; 13:209.
- Korzets Z, Plotkin E, Bernheim J, Zissin R. The clinical spectrum of acute renal infarction. Isr Med Assoc J 2002; 4:781.
- Lessman RK, Johnson SF, Coburn JW, Kaufman JJ. Renal artery embolism: clinical features and long-term follow-up of 17 cases. Ann Intern Med 1978; 89:477.
- London IL, Hoffsten P, Perkoff GT, Pennington TG. Renal infarction. Elevation of serum and urinary lactic dehydrogenase (LDH). Arch Intern Med 1968; 121:87.
- Winzelberg GG, Hull JD, Agar JW, et al. Elevation of serum lactate dehydrogenase levels in renal infarction. JAMA 1979; 242:268.
- Tsai SH, Chu SJ, Chen SJ, et al. Acute renal infarction: a 10-year experience. Int J Clin Pract 2007; 61:62.
- Kim SH, Park JH, Han JK, et al. Infarction of the kidney: role of contrast enhanced MRI. J Comput Assist Tomogr 1992; 16:924.
- Blum U, Billmann P, Krause T, et al. Effect of local low-dose thrombolysis on clinical outcome in acute embolic renal artery occlusion. Radiology 1993; 189:549.
- Moyer JD, Rao CN, Widrich WC, Olsson CA. Conservative management of renal artery embolus. J Urol 1973; 109:138.
- Steckel A, Johnston J, Fraley DS, et al. The use of streptokinase to treat renal artery thromboembolism. Am J Kidney Dis 1984; 4:166.
- Salam TA, Lumsden AB, Martin LG. Local infusion of fibrinolytic agents for acute renal artery thromboembolism: report of ten cases. Ann Vasc Surg 1993; 7:21.
- Rouvière O, Berger P, Béziat C, et al. Acute thrombosis of renal transplant artery: graft salvage by means of intra-arterial fibrinolysis. Transplantation 2002; 73:403.
- Cheng BC, Ko SF, Chuang FR, et al. Successful management of acute renal artery thromboembolism by intra-arterial thrombolytic therapy with recombinant tissue plasminogen activator. Ren Fail 2003; 25:665.
- Nakayama T, Okaneya T, Kinebuchi Y, et al. Thrombolytic therapy for traumatic unilateral renal artery thrombosis. Int J Urol 2006; 13:168.
- Siablis D, Liatsikos EN, Goumenos D, et al. Percutaneous rheolytic thrombectomy for treatment of acute renal-artery thrombosis. J Endourol 2005; 19:68.
- Greenberg JM, Steiner MA, Marshall JJ. Acute renal artery thrombosis treated by percutaneous rheolytic thrombectomy. Catheter Cardiovasc Interv 2002; 56:66.
- Siezenga MA, van Overhagen H, van Buren M. [Acute occlusion of the renal artery treated by means of rheolytic thrombectomy]. Ned Tijdschr Geneeskd 2005; 149:2413.
- Pellerin O, Garçon P, Beyssen B, et al. Spontaneous renal artery dissection: long-term outcomes after endovascular stent placement. J Vasc Interv Radiol 2009; 20:1024.
- Ouriel K, Andrus CH, Ricotta JJ, et al. Acute renal artery occlusion: when is revascularization justified? J Vasc Surg 1987; 5:348.
- Haas CA, Dinchman KH, Nasrallah PF, Spirnak JP. Traumatic renal artery occlusion: a 15-year review. J Trauma 1998; 45:557.
- Haas CA, Spirnak JP. Traumatic renal artery occlusion: a review of the literature. Tech Urol 1998; 4:1.
- Nicholas GG, DeMuth WE Jr. Treatment of renal artery embolism. Arch Surg 1984; 119:278.
- Bouttier S, Valverde JP, Lacombe M, et al. Renal artery emboli: the role of surgical treatment. Ann Vasc Surg 1988; 2:161.
- ETIOLOGY AND PATHOGENESIS
- CLINICAL PRESENTATION
- Demographic features
- History and physical examination
- Laboratory manifestations
- Differential diagnosis
- General principles
- Percutaneous endovascular therapy
- - Thrombolysis and thrombectomy
- - Angioplasty
- - Summary
- SUMMARY AND RECOMMENDATIONS