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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
- Arterial hypertension
- Irregular heart rate
- Nausea, vomiting
- Oligouria, Anuria
Signs for kidney infarction are proteinuria, microhematuria or hematuria.
Signs for kidney infarction are an increase in GOT, LDH, CK (intracellular enzymes indicating necrosis) and creatinine (if significant renal tissue is affected).
Doppler ultrasonography of the kidney can quickly confirm the diagnosis in kidney infarction.
Easy diagnosis in post contrast images with wedge-shaped areas without contrast enhancement [fig. partial renal infarction]. The cortical rim sign is seen in 50% of the patients after several hours or days of infarction: a thin rim of cortex enhances due to collateral capsular perfusion.
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 acute vascular occlusion with the option for invasive treatment..
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.
PTA or Surgical Therapy:
Percutaneous transluminal angioplasty or vascular surgery are indicated for patients with bilateral embolism or infarction of 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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