A 73‐year‐old Hispanic woman with hypertension, atrial fibrillation, and a recent embolic stroke had acute onset of diffuse abdominal pain while cooking breakfast. This severe pain was exacerbated by movement, temporarily relieved by aspirin and nitroglycerin administered by EMS personnel and had localized to her right flank by the time of admission; she denied hematuria, chest pain, shortness of breath, hematochezia or melena. She had not been taking her prescribed warfarin or ace‐inhibitor. Physical examination revealed a blood pressure of 198/81 mm Hg; her other vital signs were normal. She had an irregularly irregular heart rhythm and right CVA tenderness; there was no abdominal guarding or rebound tenderness. She remained neurologically intact, with the exception of baseline aphasia from her recent stroke. Laboratory studies revealed a marked leukocytosis of 26,000/mm3, elevation in the AST to 81 IU/L, a subtherapeutic INR of 1.2 and a rise in her creatinine from 1.0 mg/dL to 2.45 mg/dL; urinalysis and other chemistries were normal. EKG showed atrial fibrillation. CT of the abdomen and pelvis displayed an acute 4.4 × 6.0 cm wedge‐shaped infarct of the inferior segment of the right kidney. Due to the large size of the infarct and the history of her recent embolic stroke, she did not undergo an endovascular repair. She was anticoagulated with heparin. Her ace‐inhibitor was resumed and her blood pressure improved to her baseline of 140/90 mm Hg. Over the next 2 weeks her creatinine returned to normal.
Renal infarcts are an underdiagnosed entity, often mistaken for pyelonephritis or renal colic. Delayed or missed diagnosis can result in irreversible loss of renal function and increased morbidity. Hypoperfused segments of the kidney result in activation of the renin‐angiotensin system, ultimately causing elevated blood pressure. Ace‐inhibitors or angiotensin receptor blockers effectively treat this hypertension. Duration of symptoms of less than three days or persistent hypertension are indications for endovascular intervention with renal angiography and thrombolytics. Patients with atrophic kidneys or recent cerebrovascular ischemia are not candidates for reperfusion therapy and are treated with anticoagulation alone.
Early diagnosis of renal infarcts allows for endovascular interventions and improved renal outcomes. Hypertension is often transient and responsive to ace‐inhibitor or angiotensin receptor blocker therapy. This case illustrates that timely diagnosis and intervention of renal infarcts improves patient outcomes.
To cite this abstract:Latthe A, Cowart J, Bates J. Renal Infarcts: A Case Report and Literature Review. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 485. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/renal-infarcts-a-case-report-and-literature-review/. Accessed January 18, 2020.