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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

• 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:

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).

References

  Deutsche Version: Niereninfarkt