Twenty‐two year‐old Nigerian man was admitted with acute right‐sided flank pain. He denied fever, frequency, dysuria, hematuria, palpitations, similar episodes in the past, or use of medications. He reported history of sickle cell trait. He denied tobacco, excessive alcohol, cocaine, or IV drug use, but he admitted to smoking marijuana. He denied previous history of thromboembolic events. Physical exam was unremarkable.
Initial workup was remarkable only for WBC of 18. Urine and blood cultures were negative. Urine drug screen was positive for cannabinoids. Abdominal CT scan with contrast (following CT scan without contrast) showed 2 wedge‐shaped infarcts involving the upper and lower poles of the right kidney. Patient was started on IV heparin and oral Coumadin in addition to lisinopril.
Subsequent workup showed ESR 86, ANA negative, HIV serology negative, hypercoagulability screen negative, blood smear showed no sickle or target cells, C3 normal, C4 elevated 72, LDH 415. Urinalysis was normal without hematuria or proteinuria.
Hemoglobin electrophoresis showed HbA 64%, HbC 32%, HbA2 3.2, HbF 0.4, and HbS 0.0, a picture compatible with hemoglobin C trait.
TTE was normal . TEE was not found to be clinically indicated. Renal artery U/S shows no evidence of stenosis bilaterally.
The most common symptoms of renal infarction are abdominal or flank pain, nausea, and vomiting. These complaints may be accompanied by an acute elevation in blood pressure. Leukocytosis and elevated LDH are the most prominent laboratory findings. If there is no evidence of stone disease on unenhanced spiral CT, a contrast CT scan should be performed to assess for renal infarction. The classic finding is a wedge‐shaped perfusion defect.
The most common causes of renal infarction are atheroemboli from a thrombus in the heart or aorta, and in‐situ thrombosis of a renal artery, which is less common.
We are reporting a case of renal infarction in that was confirmed with contrast CT in association with hemoglobin C trait in a patient from northern Africa. Hemoglobin C disease is an autosomal recessive disorder. In the United States, hemoglobin C disease has a prevalence of 0.017% in African Americans. Overall, hemoglobin C disease is considered one of the benign hemoglobinopathies. Although hemoglobin C is a non‐sickling hemoglobinopathy, this unstable hemoglobin precipitates in RBCs to form crystals. These intracellular crystals lead to a decrease in RBC deformability and an increase in the viscosity of the blood. In theory, this may impede the passage of intravascular erythrocytes leading to renal ischemia and infarction. There are a few reports of hematuria in a possible association with hemoglobin C trait. To our knowledge, there is no report of renal infarction in association with hemoglobin C trait. Interestingly enough, our patient also smokes marijuana, albeit, occasionally. In our research we found one case report of acute renal infarction in a patient with heavy marijuana smoking.
In summary, we are reporting a unique association between renal infarction and hemoglobin C trait. At this point there is no evidence of a causal relationship. However, we are adding to the suggestion of previous authors to keep a low index of suspicion for renal infarction and avoid delay in diagnosis and initiate treatment in a timely fashion especially in patients with hemoglobinopathies and drug use, and vice versa.
To cite this abstract:Abdulhadi M, Dalaly F, Hannoudi G. Renal Infarction in Association with Hemoglobin C Trait. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 296. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/renal-infarction-in-association-with-hemoglobin-c-trait/. Accessed March 28, 2020.