Kidney Infarction

Definition of Renal Artery Embolism and Kidney Infarction

Renal artery embolism leads to a sudden interruption of blood flow in the renal artery or their main segmental branches and to ischemic kidney infarction. A hemorrhagic renal infarction can be the result from a renal vein thrombosis.

Etiology (Causes) of Kidney Infarction

Thromboembolic event (90%). Risk factors are atrial fibrillation, mitral valve disease, coronary heart disease, heart failure, other heart diseases, cardiac surgery, aortic aneurysm, renal artery aneurysm or renal artery stenosis.
Hemorrhagic renal infarction due to renal vein thrombosis

Signs and Symptoms

Flank pain or abdominal pain
Hematuria
Arterial hypertension
Irregular heart rate
Nausea, vomiting
Oligouria, Anuria

Diagnostic Work-Up

Urine:

Signs for kidney infarction are proteinuria, microhematuria or hematuria.

Laboratory tests:

Signs for kidney infarction are an increase in GOT, LDH, CK (intracellular enzymes indicating necrosis) and creatinine (if significant renal tissue is affected).

Ultrasonography:

Doppler ultrasonography of the kidney can quickly confirm the diagnosis in kidney infarction.

Abdominal CT:

After administration of contrast media, complete kidney infarction is identified by a nonenhancing kidney with cortical rim sign: the outer 2–4 mm are enhancing due to the perfusion by capsular branches. Partial kidney infarction leads to wedge-shaped areas of nonenhancing renal tissue [fig. partial renal infarction].

fig. computed tomography of a left-sided partial renal infarction

Computed tomography of a left-sided partial renal infarction. Additional finding: a partial splenic infarction can be seen. By courtesy, Prof. Dr. K. Bohndorf, Augsburg.

Digital subtraction angiography (DSA):

Gold standard for diagnosis of vascular occlusion.

Treatment of Kidney Infarction

Conservative Treatment of Kidney Infarction:

Cornerstones of conservative treatment are analgesics, regulation of blood pressure and systemic heparinization. A thrombolytic therapy should be considered; the decision depends on the extent of infarction and the remaining renal function.

Invasive or Surgical Therapy of Kidney Infarction:

Percutaneous treatment options or surgery are indicated in bilateral embolism or in a solitary kidney, if diagnosis is made in time. The time window for successful interventions is unclear, interventions have to be done as an emergency. Please see anatomic or extra-anatomic bypass surgery (treatment of renal artery stenosis).

Urologic Surgery

Index

Renal AV fistula

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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References

Deutsche Version: Niereninfarkt

Last update

Dr. med. Dirk Manski
man...@urologielehrbuch.de