Dr. med. Dirk Manski



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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

Signs and Symptoms

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. With kind permission of 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).







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